Provider Demographics
NPI:1689042830
Name:KITZMANN, PAULA JANE (LICSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JANE
Last Name:KITZMANN
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0957
Mailing Address - Country:US
Mailing Address - Phone:218-786-8319
Mailing Address - Fax:
Practice Address - Street 1:207 PARK AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1531
Practice Address - Country:US
Practice Address - Phone:218-255-3321
Practice Address - Fax:218-237-8135
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2024-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical