Provider Demographics
NPI:1902089022
Name:KROGSTAD, JULIANNE MATTSON
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:MATTSON
Last Name:KROGSTAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JULIANNE
Other - Middle Name:
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 REGENT AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2733
Mailing Address - Country:US
Mailing Address - Phone:612-812-1896
Mailing Address - Fax:
Practice Address - Street 1:11070 183RD CIR NW STE C
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-3701
Practice Address - Country:US
Practice Address - Phone:763-633-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116085183500000X
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No183500000XPharmacy Service ProvidersPharmacist