Provider Demographics
NPI:1336620137
Name:ENGEBRETSON, KARA ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:ANN
Last Name:ENGEBRETSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2424
Mailing Address - Country:US
Mailing Address - Phone:641-430-5704
Mailing Address - Fax:
Practice Address - Street 1:12000 ELM CREEK BLVD N STE 250
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7164
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty