Provider Demographics
NPI:1033446331
Name:KUENZEL, DENAE R (PSYD, LP)
Entity type:Individual
Prefix:
First Name:DENAE
Middle Name:R
Last Name:KUENZEL
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21308 JOHN MILLESS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4870
Mailing Address - Country:US
Mailing Address - Phone:637-445-9758
Mailing Address - Fax:
Practice Address - Street 1:253 8TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1581
Practice Address - Country:US
Practice Address - Phone:763-441-3770
Practice Address - Fax:763-441-9057
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2866133V00000X
MNLP6407103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered