Healthcare Provider Details

I. General information

NPI: 1689042830
Provider Name (Legal Business Name): PAULA JANE KITZMANN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 05/26/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 PARK AVE S
PARK RAPIDS MN
56470-1531
US

IV. Provider business mailing address

PO BOX 957
PARK RAPIDS MN
56470-0957
US

V. Phone/Fax

Practice location:
  • Phone: 218-255-3321
  • Fax: 218-237-8135
Mailing address:
  • Phone: 218-786-8319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4176
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: