Smallwood, Kent David

Smallwood, Kent David is an individual health care provider with primary practice located at 15251 Pleasant Valley Rd # Co7 , Center City MN 55012-9640. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Smallwood, Kent David can be contacted via phone (651) 213-4169.

Contact Information

Primary practice address
15251 Pleasant Valley Rd # Co7 Center City MN 55012-9640
Phone: (651) 213-4169
Fax: (651) 213-4515
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP5358 Minnesota

Profile Details

NPI number 1679767016
LBN Legal business name Smallwood, Kent David
Credentials PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 29th, 2007
Last updated Mar 11th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679767016 NPPES
Illinois MEDICAID 9058

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