Provider Demographics
NPI:1023311404
Name:SCHULTZ, KIMBERLY E (LICSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:E
Last Name:SCHULTZ
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 1:1250 MOORE LAKE DR E STE 152
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5135
Mailing Address - Country:US
Mailing Address - Phone:612-389-2332
Mailing Address - Fax:612-389-2338
Practice Address - Street 1:1250 MOORE LAKE DR E STE 152
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5135
Practice Address - Country:US
Practice Address - Phone:612-389-2332
Practice Address - Fax:612-389-2338
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN191861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical