Provider Demographics
NPI:1750148060
Name:KRAGE, KELLI RENAE
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:RENAE
Last Name:KRAGE
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 1:111 RIVERFRONT STE 410
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-3563
Mailing Address - Country:US
Mailing Address - Phone:507-474-6264
Mailing Address - Fax:507-218-8553
Practice Address - Street 1:111 RIVERFRONT STE 410
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3563
Practice Address - Country:US
Practice Address - Phone:507-474-6264
Practice Address - Fax:507-218-8553
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health