Healthcare Provider Details

I. General information

NPI: 1386166007
Provider Name (Legal Business Name): CHRISTINE EMMA OPITZ LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR # 116A
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

3516 PARK AVE
MINNEAPOLIS MN
55407-2022
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-3980
  • Fax: 612-629-7718
Mailing address:
  • Phone: 612-418-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20961
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: