Provider Demographics
NPI:1316210255
Name:KURZMANN, JOANNE SUSAN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:SUSAN
Last Name:KURZMANN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JO
Other - Middle Name:
Other - Last Name:KURZMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:7039 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-9737
Mailing Address - Country:US
Mailing Address - Phone:651-288-0332
Mailing Address - Fax:651-288-0493
Practice Address - Street 1:7039 20TH AVE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MN
Practice Address - Zip Code:55038-9737
Practice Address - Country:US
Practice Address - Phone:651-288-0332
Practice Address - Fax:651-288-0493
Is Sole Proprietor?:No
Enumeration Date:2012-02-22
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN174481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1316210255Medicaid
MNH400203424OtherMEDICARE PTAN