Provider Demographics
NPI:1114571734
Name:KEMEN, ANGELA MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:KEMEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RAILROAD ST SE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1540
Mailing Address - Country:US
Mailing Address - Phone:320-629-7600
Mailing Address - Fax:651-925-0071
Practice Address - Street 1:705 HILLSIDE AVE SW
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1466
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:651-925-0071
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN142631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical