Provider Demographics
NPI:1083944367
Name:TAMARA L. KAISER LLC
Entity Type:Organization
Organization Name:TAMARA L. KAISER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, PHD LICSW, LMFT
Authorized Official - Phone:612-825-8053
Mailing Address - Street 1:2301 COMO AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1742
Mailing Address - Country:US
Mailing Address - Phone:612-825-8053
Mailing Address - Fax:
Practice Address - Street 1:2301 COMO AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1742
Practice Address - Country:US
Practice Address - Phone:612-825-8053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN011581041C0700X
MN216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4G751KAOtherBLUE CROSS
MN62-28270OtherUBH