Healthcare Provider Details

I. General information

NPI: 1720176860
Provider Name (Legal Business Name): CONNIE ANN SCHULTZ MS, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12533 355TH ST
AVON MN
56310-8736
US

IV. Provider business mailing address

12533 355TH ST
AVON MN
56310-8736
US

V. Phone/Fax

Practice location:
  • Phone: 320-363-8877
  • Fax: 320-363-8821
Mailing address:
  • Phone: 320-363-8877
  • Fax: 320-363-8821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6485LICSW
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6485LICSW
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6485LICSW
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: