Individual
AMY PATRICE KUUSISTO-LATHROP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
6200 SHINGLE CREEK PKWY STE 350, BROOKLYN CENTER, MN 55430-2155
(763) 503-8560
(763) 503-8563
Mailing address
4240 PARK GLEN RD, ST LOUIS PARK, MN 55416-5427
(612) 925-6033
(612) 925-8496
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10798
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29155880
—
MN
Enumeration date
12/31/2006
Last updated
01/18/2023
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