MEDICARE: KRISTEN MARY SCHMIDT-SHAY 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
1	1041C0700X	Clinical Social Worker	14824	MN

General Provider Information

NPI Number	:	1740362300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN MARY SCHMIDT-SHAY LICSW

Provider Business Mailing Address
First Line	:	3100 W LAKE ST
Second Line	:	SUITE 210
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4527
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

Provider Business Practice Location Address
First Line	:	3100 W LAKE ST
Second Line	:	SUITE 210
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-4527
Country	:	US
Telephone Number	:	612-925-6033
Fax Number	:	612-925-8496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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Directions to “ KRISTEN MARY SCHMIDT-SHAY LICSW” Practice Location

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