Provider Demographics
NPI:1114194719
Name:KUJAWA, NANCY K (LSW LADC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:KUJAWA
Suffix:
Gender:F
Credentials:LSW LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 GATEWAY DR NE
Mailing Address - Street 2:
Mailing Address - City:EAST GRAND FORKS
Mailing Address - State:MN
Mailing Address - Zip Code:56721-2620
Mailing Address - Country:US
Mailing Address - Phone:218-793-0420
Mailing Address - Fax:
Practice Address - Street 1:1111 GATEWAY DR NE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-2620
Practice Address - Country:US
Practice Address - Phone:218-793-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302314101YA0400X
MN178761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical