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General NPI Number Information
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NPI Number | 1326860859
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Entity Type | Organization
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Legal Business Name | KIMBERLY ENDRES LLC
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 3115 HENNEPIN AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55408-2620
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Country | US
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Telephone | 612-444-9741
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Fax | 612-484-4064
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Provider Business Mailing Address
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Address Line | 1223 JUNO AVE
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City | SAINT PAUL
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State | MN
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Zip | 55116-1659
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Country | US
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Telephone | 612-715-3933
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Fax | 651-333-4746
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY J ENDRES
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Credential | MSW LICSW
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Telephone | 612-715-3933
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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 |
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License Number State |
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