Provider Demographics
NPI:1598919573
Name:GROEN, COLEEN MACLEAN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:MACLEAN
Last Name:GROEN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 AKAHI ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1105
Mailing Address - Country:US
Mailing Address - Phone:808-634-0431
Mailing Address - Fax:808-632-2010
Practice Address - Street 1:8550 HUDSON BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-5500
Practice Address - Country:US
Practice Address - Phone:651-254-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-38491041C0700X
MN269111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical