Provider Demographics
NPI:1699180489
Name:WEBB, KIRSTEN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 STONE CREEK DR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-4605
Mailing Address - Country:US
Mailing Address - Phone:507-990-2696
Mailing Address - Fax:
Practice Address - Street 1:7945 STONE CREEK DR
Practice Address - Street 2:SUITE 140
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4605
Practice Address - Country:US
Practice Address - Phone:507-990-2696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN176591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical