Provider Demographics
NPI:1366330797
Name:KELLOGG, JAMES JOSEPH
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:KELLOGG
Suffix:
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:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:EMILY
Mailing Address - State:MN
Mailing Address - Zip Code:56447-0243
Mailing Address - Country:US
Mailing Address - Phone:763-234-2091
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 243
Practice Address - Street 2:
Practice Address - City:EMILY
Practice Address - State:MN
Practice Address - Zip Code:56447-0243
Practice Address - Country:US
Practice Address - Phone:763-234-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305361101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)