Provider Demographics
NPI:1679243125
Name:FITZGERALD, SIOBHAN (LICSW)
Entity Type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:
Last Name:FITZGERALD
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 1:5125 COUNTY ROAD 101 STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4157
Mailing Address - Country:US
Mailing Address - Phone:952-932-7277
Mailing Address - Fax:952-932-9827
Practice Address - Street 1:5125 COUNTY ROAD 101 STE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4157
Practice Address - Country:US
Practice Address - Phone:952-932-7277
Practice Address - Fax:952-932-9827
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24016104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker