Healthcare Provider Details

I. General information

NPI: 1881500072
Provider Name (Legal Business Name): MRS. KIMBERLY MAE CZARNESKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W SUPERIOR ST STE 760
DULUTH MN
55802-2033
US

IV. Provider business mailing address

4835 HIGHWAY 73
FLOODWOOD MN
55736-8416
US

V. Phone/Fax

Practice location:
  • Phone: 218-552-4469
  • Fax:
Mailing address:
  • Phone: 920-915-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3857
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: