Provider Demographics
NPI:1982886503
Name:VOLKMANN, KELLY RENEE (MSW, LICSW, LADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:VOLKMANN
Suffix:
Gender:F
Credentials:MSW, LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 COMMERCE DRIVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-442-8214
Mailing Address - Fax:651-735-7844
Practice Address - Street 1:700 COMMERCE DRIVE
Practice Address - Street 2:SUITE 295
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-442-8214
Practice Address - Fax:651-735-7844
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301542101YA0400X
MN152511041C0700X
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)