Provider Demographics
NPI:1750976437
Name:SCHULTZ, CHRISTINA A (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:A
Other - Last Name:WOELFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6300 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-9301
Mailing Address - Country:US
Mailing Address - Phone:952-913-5230
Mailing Address - Fax:
Practice Address - Street 1:8340 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-9578
Practice Address - Country:US
Practice Address - Phone:952-913-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN296811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical