Provider Demographics
NPI:1972764454
Name:KIRLIN, LAURA LYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LYNN
Last Name:KIRLIN
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 1:515 BRIDGE ST. EAST
Mailing Address - Street 2:P.O. BOX 806
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-1810
Mailing Address - Country:US
Mailing Address - Phone:218-366-9229
Mailing Address - Fax:218-237-2520
Practice Address - Street 1:515 BRIDGE ST. EAST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1810
Practice Address - Country:US
Practice Address - Phone:218-366-9229
Practice Address - Fax:218-237-2520
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
MN292031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner