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NPI Code Detail

MEDICARE: KRISTEN GARA ENGEN-ROUTZOHN LICSW

MEDICARE: KRISTEN GARA ENGEN-ROUTZOHN 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 Worker18299MN

General Provider Information

NPI Number : 1790041895
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN GARA ENGEN-ROUTZOHN LICSW
Provider Business Mailing Address
First Line : 7600 BOONE AVE N
Second Line : SUITE 2
City : BROOKLYN PARK
State : MN
Zip : 55428
Country : US
Telephone Number : 763-504-7669
Fax Number :
Provider Business Practice Location Address
First Line : 7600 BOONE AVE N
Second Line : SUITE 2
City : BROOKLYN PARK
State : MN
Zip : 55428-4563
Country : US
Telephone Number : 763-504-7669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2012
Last Update Date : 04/03/2012

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