MEDICARE: KRISTIN GLOE-THORDIN THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013606425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTIN GLOE-THORDIN THERAPY

Provider Business Mailing Address
First Line	:	4108 PARK AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3129
Country	:	US
Telephone Number	:	763-807-4145
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S STE 244
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-3197
Country	:	US
Telephone Number	:	612-470-7852
Fax Number	:

Authorized Official
Title or Position	:	OWNER, MENTAL HEALTH THERAPIST
Name	:	MS. KRISTIN GLOE-THORDIN
Credential	:
Telephone Number	:	612-470-7852

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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