Basic Information
| Provider Information | |||||||||
| NPI: | 1417413501 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHULTZ HENRICKSEN | ||||||||
| FirstName: | ASHLEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCHULTZ | ||||||||
| OtherFirstName: | ASHLEY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LGSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6600 FRANCE AVE S STE 230 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554351810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524609000 | ||||||||
| FaxNumber: | 9528359889 | ||||||||
| Practice Location | |||||||||
| Address1: | 6600 FRANCE AVE S STE 230 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554351810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524609000 | ||||||||
| FaxNumber: | 9528359889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2019 | ||||||||
| LastUpdateDate: | 02/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 25666 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.