Provider Demographics
NPI:1174707566
Name:KUZNIA, COLETTE CLARICE (MED MASTERS DEGREE I)
Entity type:Individual
Prefix:MS
First Name:COLETTE
Middle Name:CLARICE
Last Name:KUZNIA
Suffix:
Gender:F
Credentials:MED MASTERS DEGREE I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 CENTER AVE
Mailing Address - Street 2:SUITE 405 COLETTE C KUZNIA
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560
Mailing Address - Country:US
Mailing Address - Phone:218-233-9426
Mailing Address - Fax:
Practice Address - Street 1:403 CENTER AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-233-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00117101Y00000X
ND25811117101Y00000X
30474101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH300126937Medicare PIN