Provider Demographics
NPI:1790041895
Name:ENGEN-ROUTZOHN, KRISTEN GARA (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GARA
Last Name:ENGEN-ROUTZOHN
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 1:7600 BOONE AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428
Mailing Address - Country:US
Mailing Address - Phone:763-504-7669
Mailing Address - Fax:
Practice Address - Street 1:7600 BOONE AVE N
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-4563
Practice Address - Country:US
Practice Address - Phone:763-504-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN182991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical