Healthcare Provider Details

I. General information

NPI: 1790127199
Provider Name (Legal Business Name): KARI LEAH VACINEK M.S.W., L.I.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 78TH ST STE 10
CHANHASSEN MN
55317-2601
US

IV. Provider business mailing address

680 DRESDEN DR
CHASKA MN
55318-1478
US

V. Phone/Fax

Practice location:
  • Phone: 952-405-9369
  • Fax:
Mailing address:
  • Phone: 952-405-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19931
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: