Healthcare Provider Details

I. General information

NPI: 1881217487
Provider Name (Legal Business Name): KELSIE RAE HOPKINS LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W SUPERIOR ST STE 101
DULUTH MN
55806-1857
US

IV. Provider business mailing address

2701 W SUPERIOR ST STE 101
DULUTH MN
55806-1857
US

V. Phone/Fax

Practice location:
  • Phone: 218-733-0707
  • Fax:
Mailing address:
  • Phone: 218-733-0707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28365
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: