Healthcare Provider Details

I. General information

NPI: 1689280323
Provider Name (Legal Business Name): BRITTANY ANNMARIE BARKHOLTZ MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 UNIVERSITY AVE W STE 435S
SAINT PAUL MN
55114-1907
US

IV. Provider business mailing address

2550 UNIVERSITY AVE W STE 435S
SAINT PAUL MN
55114-1907
US

V. Phone/Fax

Practice location:
  • Phone: 651-647-1900
  • Fax: 651-647-1861
Mailing address:
  • Phone: 651-647-1900
  • Fax: 651-647-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: