Provider Demographics
NPI:1801297577
Name:KUDRLE, DOREEN (LMFT)
Entity type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:KUDRLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 WAYZATA BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1377
Mailing Address - Country:US
Mailing Address - Phone:952-361-3360
Mailing Address - Fax:952-513-7968
Practice Address - Street 1:1107 HAZELTINE BLVD STE 121
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1065
Practice Address - Country:US
Practice Address - Phone:952-361-3360
Practice Address - Fax:952-513-7968
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist