Provider Demographics
NPI:1134412646
Name:KILLEN, TOU JEAN (LSW)
Entity type:Individual
Prefix:MS
First Name:TOU
Middle Name:JEAN
Last Name:KILLEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:TOU
Other - Middle Name:JEAN
Other - Last Name:VANSIEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2067
Mailing Address - Country:US
Mailing Address - Phone:612-229-3332
Mailing Address - Fax:
Practice Address - Street 1:720 E 33RD ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-2067
Practice Address - Country:US
Practice Address - Phone:612-229-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16065104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker