Healthcare Provider Details

I. General information

NPI: 1437581329
Provider Name (Legal Business Name): SCOTT WILLIAM KROHN MSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W LAKE ST STE 210
MINNEAPOLIS MN
55416-4597
US

IV. Provider business mailing address

1201 HARMON PL
MINNEAPOLIS MN
55403-2043
US

V. Phone/Fax

Practice location:
  • Phone: 612-925-6033
  • Fax: 612-925-8496
Mailing address:
  • Phone: 612-313-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number22564
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22564
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: