Provider Demographics
NPI:1346466992
Name:SCHULTZ, BROOKE AMBER (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:AMBER
Last Name:SCHULTZ
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 1:400 SIBLEY ST
Mailing Address - Street 2:STE 500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1941
Mailing Address - Country:US
Mailing Address - Phone:651-256-1260
Mailing Address - Fax:651-256-1272
Practice Address - Street 1:190 5TH ST E
Practice Address - Street 2:STE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2666
Practice Address - Country:US
Practice Address - Phone:651-389-4690
Practice Address - Fax:651-389-4691
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN164101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical