Provider Demographics
NPI:1639953102
Name:WEISHOFF, KARLIE JO (LICSW)
Entity Type:Individual
Prefix:
First Name:KARLIE
Middle Name:JO
Last Name:WEISHOFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KARLIE
Other - Middle Name:JO
Other - Last Name:KORISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 ARMSTRONG CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4904
Mailing Address - Country:US
Mailing Address - Phone:608-566-6904
Mailing Address - Fax:
Practice Address - Street 1:621 W LAKE ST STE 350
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2952
Practice Address - Country:US
Practice Address - Phone:612-979-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29517104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker