Individual
KIRA LARSON FIELDSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
2400 BLAISDELL AVE., MINNEAPOLIS, MN 55404
(612) 516-5472
Mailing address
3440 17TH AVE S, MINNEAPOLIS, MN 55407
(612) 735-1253
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
25897
MN
Other
Enumeration date
09/13/2017
Last updated
09/13/2017
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