Provider Demographics
NPI:1598083404
Name:ECKSTROM, KAREN LEE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:ECKSTROM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 FRANCE AVE., S. SUITE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-913-5403
Mailing Address - Fax:952-831-9000
Practice Address - Street 1:7300 FRANCE AVE., S.
Practice Address - Street 2:SUTE #208
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-913-5403
Practice Address - Fax:952-831-9000
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10192104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker