Provider Demographics
NPI:1558199273
Name:SERREYN, MIKAELA JEAN
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:JEAN
Last Name:SERREYN
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 1:104 N COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:GHENT
Mailing Address - State:MN
Mailing Address - Zip Code:56239-9771
Mailing Address - Country:US
Mailing Address - Phone:507-829-5398
Mailing Address - Fax:
Practice Address - Street 1:349 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-1361
Practice Address - Country:US
Practice Address - Phone:507-337-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician