Individual
MS. KATHLEEN CONNOLLY-PIUMBROECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
3100 W LAKE ST, STE 320, MINNEAPOLIS, MN 55416-4527
(612) 928-1975
(612) 929-9006
Mailing address
6255 WESSEL CT, EDEN PRAIRIE, MN 55346-1126
(952) 949-0660
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
04921
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1472721
MN TAX ID NUMBER
MN
Enumeration date
10/23/2006
Last updated
07/08/2007
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