Provider Demographics
NPI:1043504145
Name:WILKINSON, KELLY LEE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LEE
Last Name:WILKINSON
Suffix:
Gender:
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LEE
Other - Last Name:RAJEWSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18484 KACHINA CT
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4886
Practice Address - Country:US
Practice Address - Phone:952-993-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional