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General NPI Number Information
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NPI Number | 1376765529
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Entity Type | Organization
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Legal Business Name | CHILD FAMILY SPECIALTY CLINIC, P.A.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 4826 CHICAGO AVENUE SOUTH STE 206
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City | MINNEAPOLIS
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State | MN
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Zip | 55417
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Country | US
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Telephone | 612-821-1920
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Fax |
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Provider Business Mailing Address
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Address Line | 4826 CHICAGO AVENUE SOUTH STE 206
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City | MINNEAPOLIS
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State | MN
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Zip | 55417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEANNIE GILFIX
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Credential |
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Telephone | 612-821-1920
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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 | 9839
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15301
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1075
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 00215
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License Number State | MN
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