Basic Information
Provider Information
NPI: 1750516068
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAPLAN
FirstName: ADRIENNE
MiddleName: LOU
NamePrefix:  
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1322 ALTON ST
Address2: #219
City: SAINT PAUL
State: MN
PostalCode: 551163109
CountryCode: US
TelephoneNumber: 6513354340
FaxNumber:  
Practice Location
Address1: 1919 UNIVERSITY AVE W
Address2: SUITE 200
City: SAINT PAUL
State: MN
PostalCode: 551043453
CountryCode: US
TelephoneNumber: 6512667900
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/17/2009
LastUpdateDate: 05/17/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X14775MNY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


Home