Provider Demographics
NPI:1255439568
Name:KOHL, VICTORIA IRWIN (LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:IRWIN
Last Name:KOHL
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 1:821 RAYMOND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1503
Mailing Address - Country:US
Mailing Address - Phone:651-789-0489
Mailing Address - Fax:651-304-1400
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:651-789-0489
Practice Address - Fax:651-304-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN446397800Medicaid
MN800001997OtherMEDICARE PTAN