Healthcare Provider Details

I. General information

NPI: 1083944367
Provider Name (Legal Business Name): TAMARA L. KAISER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 COMO AVE STE 204
SAINT PAUL MN
55108-1742
US

IV. Provider business mailing address

2301 COMO AVE STE 204
SAINT PAUL MN
55108-1742
US

V. Phone/Fax

Practice location:
  • Phone: 612-825-8053
  • Fax:
Mailing address:
  • Phone: 612-825-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01158
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number216
License Number StateMN

VIII. Authorized Official

Name: DR. TAMARA LYNN KAISER
Title or Position: CLINICAL SOCIAL WORKER
Credential: MSW, PHD LICSW, LMFT
Phone: 612-825-8053