Healthcare Provider Details

I. General information

NPI: 1306403191
Provider Name (Legal Business Name): DOROTHEA KINZLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 3RD ST NW
JAMESTOWN ND
58401-2968
US

IV. Provider business mailing address

520 3RD ST NW
JAMESTOWN ND
58401-2968
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-6300
  • Fax:
Mailing address:
  • Phone: 701-253-6300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5909
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: