Provider Demographics
NPI:1063882520
Name:DEETZ, JONI CHRISTINE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:CHRISTINE
Last Name:DEETZ
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:CHRISTINE
Other - Last Name:NORDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:2000 W SUPERIOR ST STE 204
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 W SUPERIOR ST STE 204
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-2908
Practice Address - Country:US
Practice Address - Phone:218-721-8169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN224111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical