Provider Demographics
NPI:1821196882
Name:KAMINSKI-SCHMIDT, KATHRYN M (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:M
Last Name:KAMINSKI-SCHMIDT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:
Practice Address - Street 1:13603 80TH CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-8961
Practice Address - Country:US
Practice Address - Phone:763-274-3120
Practice Address - Fax:763-274-3121
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN160501041C0700X
MNLICSW160501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN572407400Medicaid
MN607K1KAOtherBLUE CROSS BLUE SHEILD
MN990991046376OtherPREFERRED ONE
MNHP58094OtherHEALTHPARTNERS