Individual
MS. LISA RENEE KIESEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1599 SELBY AVE # 2, .SUITE 106, SAINT PAUL, MN 55104-6218
(612) 251-7967
Mailing address
1599 SELBY AVE # 2, .SUITE 106, SAINT PAUL, MN 55104-6218
(612) 251-7967
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10301
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800002196
MEDICARE
MN
05
—
866412900
—
MN
Enumeration date
08/15/2006
Last updated
05/27/2009
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