Provider Demographics
NPI:1174566368
Name:KIRCHNER, JODY ANN (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:ANN
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:MS
Other - First Name:JODY
Other - Middle Name:ANN
Other - Last Name:MARECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:1406 6TH AVENUE NORTH
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1901
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7115
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST CLOUD HOSPITAL
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7115
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10908104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
136782C851OtherUCARE
6252030OtherMEDICA
MN352192300Medicaid
HP39294OtherHEALTH PARTNERS
218727OtherOPTUM
68G64K1OtherBCBS
922241034347OtherPREFERRED ONE
HP39294OtherHEALTH PARTNERS