Provider Demographics
NPI:1225641848
Name:KOOLICK, DELIA MELISSA
Entity Type:Individual
Prefix:
First Name:DELIA
Middle Name:MELISSA
Last Name:KOOLICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 7TH ST SE APT 206
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1454
Mailing Address - Country:US
Mailing Address - Phone:763-248-4338
Mailing Address - Fax:
Practice Address - Street 1:5701 KENTUCKY AVE N STE 201
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3394
Practice Address - Country:US
Practice Address - Phone:763-568-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical