Healthcare Provider Details

I. General information

NPI: 1457550147
Provider Name (Legal Business Name): KIMBERLY KAY SCHNEIDER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ADRIAN DR
CHASKA MN
55318-1582
US

IV. Provider business mailing address

1210 ADRIAN DR
CHASKA MN
55318-1582
US

V. Phone/Fax

Practice location:
  • Phone: 952-250-2697
  • Fax:
Mailing address:
  • Phone: 952-250-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15945
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: