Provider Demographics
NPI:1447998299
Name:DUFFNEY, CALLIEGH
Entity type:Individual
Prefix:
First Name:CALLIEGH
Middle Name:
Last Name:DUFFNEY
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 1:12697 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-4805
Mailing Address - Country:US
Mailing Address - Phone:218-831-5337
Mailing Address - Fax:
Practice Address - Street 1:204 2ND ST NW
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1226
Practice Address - Country:US
Practice Address - Phone:218-429-0105
Practice Address - Fax:218-429-0209
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health