Provider Demographics
NPI:1134291024
Name:TRAEN, KENNETH RAYMOND (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAYMOND
Last Name:TRAEN
Suffix:
Gender:M
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 1:1976 MONTREAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2009
Mailing Address - Country:US
Mailing Address - Phone:612-414-2533
Mailing Address - Fax:
Practice Address - Street 1:2050 SAINT CLAIR AVE
Practice Address - Street 2:SUITE 1E
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1650
Practice Address - Country:US
Practice Address - Phone:612-414-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical