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NPI Code Detail

MEDICARE: KATHRYN WEINTZ LICSW

MEDICARE: KATHRYN WEINTZ LICSW
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
11041C0700XClinical Social Worker17039MN

General Provider Information

NPI Number : 1306163936
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN WEINTZ LICSW
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line : SUITE 110
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-379-1704
Fax Number :
Provider Business Practice Location Address
First Line : 13100 WAYZATA BLVD STE 200
Second Line :
City : MINNETONKA
State : MN
Zip : 55305-1810
Country : US
Telephone Number : 952-206-2040
Fax Number : 952-206-2041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2010
Last Update Date : 05/08/2019

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Directions to “ KATHRYN WEINTZ LICSW” Practice Location

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