Provider Demographics
NPI:1073687885
Name:SMITH, KIM HILL (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:HILL
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:ELLEN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3209 WEST 76TH STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5246
Mailing Address - Country:US
Mailing Address - Phone:952-285-5566
Mailing Address - Fax:952-925-5614
Practice Address - Street 1:3209 WEST 76TH STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5246
Practice Address - Country:US
Practice Address - Phone:952-285-5566
Practice Address - Fax:952-925-5614
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN105528OtherUCARE MINNESOTA
MN23G04SMOtherBLUE CROSS BLUE SHIELD
CA201129OtherMANAGED HEALTH NETWORK
MN40058OtherBEHAVIORAL HEALTHCARE PRO
MNHP19015OtherHEALTH PARTNERS
MN697921100Medicaid
MN800000979Medicare ID - Type Unspecified