Healthcare Provider Details

I. General information

NPI: 1346466992
Provider Name (Legal Business Name): BROOKE AMBER SCHULTZ MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 5TH ST E STE 100
SAINT PAUL MN
55101-2666
US

IV. Provider business mailing address

400 SIBLEY ST STE 500
SAINT PAUL MN
55101-1941
US

V. Phone/Fax

Practice location:
  • Phone: 651-389-4690
  • Fax: 651-389-4691
Mailing address:
  • Phone: 651-256-1260
  • Fax: 651-256-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16410
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: