Healthcare Provider Details

I. General information

NPI: 1366825614
Provider Name (Legal Business Name): KIRSTINA EMANS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTINA QUAST MSW LICSW

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49725 COUNTY 83
STAPLES MN
56479-5280
US

IV. Provider business mailing address

PO BOX 591
PEQUOT LAKES MN
56472-0591
US

V. Phone/Fax

Practice location:
  • Phone: 218-894-1515
  • Fax: 218-894-8767
Mailing address:
  • Phone: 218-833-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18277
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: