Provider Demographics
NPI:1619066537
Name:KAZEMEK, CHERYL (LICSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KAZEMEK
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 1:1313 5TH ST SE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-4504
Mailing Address - Country:US
Mailing Address - Phone:612-435-7205
Mailing Address - Fax:612-435-7201
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:SUITE 314
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-435-7205
Practice Address - Fax:612-435-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN112531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical