Provider Demographics
NPI:1518323625
Name:PIEPER, KELLY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PIEPER
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 1:481 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:CIRCLE PINES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-5475
Mailing Address - Country:US
Mailing Address - Phone:920-819-9770
Mailing Address - Fax:
Practice Address - Street 1:481 LINDEN LN
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-5475
Practice Address - Country:US
Practice Address - Phone:920-819-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical