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General NPI Number Information
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NPI Number | 1225502172
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Entity Type | Individual
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Provider Name | DEBORAH J LOCKETZ LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 4737 COUNTY ROAD 101 # 175
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City | MINNETONKA
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State | MN
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Zip | 55345-2634
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Country | US
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Telephone | 952-208-6700
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Fax | 952-208-6343
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Provider Business Mailing Address
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Address Line | 4737 COUNTY ROAD 101 # 175
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City | MINNETONKA
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State | MN
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Zip | 55345-2634
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Country | US
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Telephone | 952-208-6700
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Fax | 952-208-6343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19841
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License Number State | MN
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