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NPI Code Detail

MEDICARE: KIMBERLY JEAN ENDRES MSW, LICSW

MEDICARE: KIMBERLY JEAN ENDRES MSW, 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 Worker16550MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689696130
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JEAN ENDRES MSW, LICSW
Provider Business Mailing Address
First Line : 1223 JUNO AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1659
Country : US
Telephone Number : 612-715-3933
Fax Number : 651-333-4746
Provider Business Practice Location Address
First Line : 3115 HENNEPIN AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-2620
Country : US
Telephone Number : 612-444-9741
Fax Number : 612-484-4064
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 05/26/2025

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