Provider Demographics
NPI:1285934224
Name:KUZMAN, LISA RENEE (CLINICAL SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:KUZMAN
Suffix:
Gender:F
Credentials:CLINICAL SOCIAL WORK
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENEE
Other - Last Name:TATGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MONUMENT HEALTH HOME PLUS, LLC
Mailing Address - Street 2:PO BOX 860013
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MONUMENT HEALTH HOME PLUS, LLC
Practice Address - Street 2:224 ELK STREET
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-755-7710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006892104100000X
SDCSW-PIP62771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker