Healthcare Provider Details

I. General information

NPI: 1740362300
Provider Name (Legal Business Name): KRISTEN MARY SCHMIDT-SHAY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9531 W 78TH ST STE 220
EDEN PRAIRIE MN
55344-3863
US

IV. Provider business mailing address

9531 W 78TH ST STE 220
EDEN PRAIRIE MN
55344-3863
US

V. Phone/Fax

Practice location:
  • Phone: 952-395-3290
  • Fax: 952-214-7490
Mailing address:
  • Phone: 952-395-3290
  • Fax: 952-214-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14824
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: