Provider Demographics
NPI:1902525728
Name:REINHOLDSON, KYLA MARIE
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:MARIE
Last Name:REINHOLDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14091 ELMIRA CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-4217
Mailing Address - Country:US
Mailing Address - Phone:763-229-9781
Mailing Address - Fax:
Practice Address - Street 1:6381 OSGOOD AVE N BLDG C
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6118
Practice Address - Country:US
Practice Address - Phone:612-888-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health