Provider Demographics
NPI:1912591454
Name:KJOLSING, KELSI LEE (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:LEE
Last Name:KJOLSING
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15975 COUNTY ROAD 34
Mailing Address - Street 2:
Mailing Address - City:YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55397-8402
Mailing Address - Country:US
Mailing Address - Phone:605-310-2917
Mailing Address - Fax:
Practice Address - Street 1:1000 W 140TH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4833
Practice Address - Country:US
Practice Address - Phone:952-512-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer