Provider Demographics
NPI:1649296658
Name:STOLZ, JAMES LLOYD (MSW LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LLOYD
Last Name:STOLZ
Suffix:
Gender:M
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 1:2736 HENNEPIN AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1037
Mailing Address - Country:US
Mailing Address - Phone:612-799-3696
Mailing Address - Fax:612-234-4603
Practice Address - Street 1:2736 HENNEPIN AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1037
Practice Address - Country:US
Practice Address - Phone:612-799-3696
Practice Address - Fax:612-234-4603
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN160111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800001679Medicare UPIN