Provider Demographics
NPI:1205519659
Name:SCHMIDTKE, CORRIN LEA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CORRIN
Middle Name:LEA
Last Name:SCHMIDTKE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15489 45TH ST S
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:MN
Mailing Address - Zip Code:55001-9681
Mailing Address - Country:US
Mailing Address - Phone:651-315-5254
Mailing Address - Fax:651-433-7381
Practice Address - Street 1:15489 45TH ST S
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:MN
Practice Address - Zip Code:55001-9681
Practice Address - Country:US
Practice Address - Phone:651-315-5254
Practice Address - Fax:651-433-7381
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical