Provider Demographics
NPI:1952377921
Name:KRAMER, KAREN M (LICSW)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:KRAMER
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 1:8100 34TH AVE S
Mailing Address - Street 2:21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-7961
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:5100 GAMBLE DR SUITE 100
Practice Address - Street 2:MAIL STOP 31200A
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1582
Practice Address - Country:US
Practice Address - Phone:952-593-8777
Practice Address - Fax:952-595-6408
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN698057100Medicaid
R64588Medicare UPIN
MN800001201Medicare ID - Type Unspecified