Individual
MRS. GRETCHEN SUZANNE KIRVIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
7039 20TH AVE, CENTERVILLE, MN 55038-9737
(651) 288-0332
(651) 288-0493
Mailing address
PO BOX 397, CENTER CITY, MN 55012
(651) 257-5399
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
3068
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169876
UCARE
MN
05
—
17395900
—
MN
01
—
205M6KI
BC BS
MN
01
—
4028602
BHP
MN
01
—
HP37279
HEALTH PARTNERS
MN
Enumeration date
12/11/2006
Last updated
08/03/2020
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