Basic Information
| Provider Information | |||||||||
| NPI: | 1659425031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOLMAN-STICH | ||||||||
| FirstName: | ROSEMARIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1821 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE # N-464 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551042801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516592931 | ||||||||
| FaxNumber: | 6516457307 | ||||||||
| Practice Location | |||||||||
| Address1: | 1821 UNIVERSITY AVE W | ||||||||
| Address2: | SUITE # N-464 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551042801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516592931 | ||||||||
| FaxNumber: | 6516457307 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 11202 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.