Organization
CHILD AND FAMILY SPECIALTY CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE ELLEN GILFIX (CFO)
(612) 821-1920
Entity
Organization
Contact information
Practice address
4748 CHICAGO AVE STE 1, MINNEAPOLIS, MN 55407-4311
(612) 821-1920
(612) 821-1919
Mailing address
4748 CHICAGO AVE STE 1, MINNEAPOLIS, MN 55407-4311
(952) 250-6948
(612) 821-1919
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
00215
MN
1041C0700X
Clinical Social Worker
15301
MN
1041C0700X
Clinical Social Worker
9839
MN
106H00000X
Marriage & Family Therapist
1075
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128423100
—
MN
Enumeration date
05/03/2007
Last updated
05/22/2026
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