Provider Demographics
NPI:1578983946
Name:REWEY, KIRSTEN CLARK (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:CLARK
Last Name:REWEY
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 1:4528 BRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1121
Mailing Address - Country:US
Mailing Address - Phone:952-926-4884
Mailing Address - Fax:
Practice Address - Street 1:2809 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2125
Practice Address - Country:US
Practice Address - Phone:612-377-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical