Provider Demographics
NPI:1770806531
Name:ZWOLSKI, KATIE (LICSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ZWOLSKI
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 1:1121 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3562
Mailing Address - Country:US
Mailing Address - Phone:612-204-8278
Mailing Address - Fax:612-827-9325
Practice Address - Street 1:1121 E 46TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3562
Practice Address - Country:US
Practice Address - Phone:612-204-8278
Practice Address - Fax:612-827-9325
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN185541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1235240474OtherSITE NUMBER