Provider Demographics
NPI:1922370006
Name:NORNBERG, KARLA BETH (LICSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:BETH
Last Name:NORNBERG
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 1:13596 179TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-4172
Mailing Address - Country:US
Mailing Address - Phone:320-630-8236
Mailing Address - Fax:
Practice Address - Street 1:13596 179TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-4172
Practice Address - Country:US
Practice Address - Phone:320-630-8236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN167341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical