Provider Demographics
NPI:1053910893
Name:KISSINGER, VANESSA ANN (LADC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:KISSINGER
Suffix:
Gender:F
Credentials:LADC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1246 UNIVERSITY AVE W
Mailing Address - Street 2:1246
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:763-390-7932
Mailing Address - Fax:
Practice Address - Street 1:1900 SILVER LAKE RD NW STE 110
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-1789
Practice Address - Country:US
Practice Address - Phone:651-628-9566
Practice Address - Fax:651-628-0411
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2024-11-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)