Provider Demographics
NPI:1932109808
Name:KAISER, TAMARA LYNN (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LYNN
Last Name:KAISER
Suffix:
Gender:F
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 HUMBOLDT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3329
Mailing Address - Country:US
Mailing Address - Phone:612-825-8053
Mailing Address - Fax:
Practice Address - Street 1:2301 COMO AVE
Practice Address - Street 2:#204
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1718
Practice Address - Country:US
Practice Address - Phone:612-825-8053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11581041C0700X
MN216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist