Provider Demographics
NPI:1992739262
Name:STONE, KEN J (PSY D)
Entity type:Individual
Prefix:DR
First Name:KEN
Middle Name:J
Last Name:STONE
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-461-5600
Mailing Address - Fax:701-461-5649
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-461-5600
Practice Address - Fax:701-461-5649
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDND 244103T00000X
ND244103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13475OtherBSBS OF MN PIN
ND026767OtherBCBS OF ND PIN
MN084314800Medicaid
NDN13745Medicare PIN
ND620003946Medicare PIN
ND026767OtherBCBS OF ND PIN