Provider Demographics
NPI:1437197084
Name:KUNTZ, DAWN M (LICSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1619 37TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6331
Mailing Address - Country:US
Mailing Address - Phone:701-239-4471
Mailing Address - Fax:
Practice Address - Street 1:2405 8TH ST S STE 200
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4224
Practice Address - Country:US
Practice Address - Phone:218-331-4866
Practice Address - Fax:218-331-4867
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00261628OtherRAILROAD MEDICARE
MN1031163OtherPREFERREDONE
MNHP35763OtherHEALTHPARTNERS
ND23334OtherNORRTH DAKOTA BLUE SHIELD
MN142522OtherUCARE MINNESOTA
MN155532400Medicaid
MN338S0KUOtherBLUE SHIELD OF MINNESOTA
MN62-71654OtherUNITED BEHAVIORAL HEALTH