Provider Demographics
NPI:1720614001
Name:KIRKLAND, WILLIAM I
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:KIRKLAND
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 LEXINGTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4636
Mailing Address - Country:US
Mailing Address - Phone:651-280-2310
Mailing Address - Fax:651-280-3995
Practice Address - Street 1:451 LEXINGTON PKWY N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4636
Practice Address - Country:US
Practice Address - Phone:651-280-2310
Practice Address - Fax:651-280-3995
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2024-06-20
Deactivation Date:2024-05-20
Deactivation Code:
Reactivation Date:2024-06-14
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MN4294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health