Individual
KELLY JEAN TIBBETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
4154 SHORELINE DR STE 202, SPRING PARK, MN 55384-5610
(952) 491-9450
Mailing address
PO BOX 13, WRENSHALL, MN 55797-0013
(218) 409-7508
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22636
MN
Other
Enumeration date
08/02/2019
Last updated
06/06/2025
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