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General NPI Number Information
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NPI Number | 1619452521
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Entity Type | Individual
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Provider Name | KATHLEEN J DUFFY MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/26/2018
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Last Update Date | 10/08/2018
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Provider Practice Location Address
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Address Line | 3395 PLYMOUTH RD
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City | MINNETONKA
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State | MN
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Zip | 55305-3765
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Country | US
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Telephone | 952-562-5712
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Fax |
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Provider Business Mailing Address
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Address Line | 4619 BRUNSWICK AVE N
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City | CRYSTAL
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State | MN
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Zip | 55422-1016
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Country | US
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Telephone | 763-442-9819
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Fax |
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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 | 20984
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License Number State | MN
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