1720176860 NPI number — CONNIE ANN SCHULTZ MS, LICSW

Table of content: CHELSI STEELE (NPI 1093231441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720176860 NPI number — CONNIE ANN SCHULTZ MS, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHULTZ
Provider First Name:
CONNIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720176860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12533 355TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AVON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56310-8736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-363-8877
Provider Business Mailing Address Fax Number:
320-363-8821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12533 355TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56310-8736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-363-8877
Provider Business Practice Location Address Fax Number:
320-363-8821
Provider Enumeration Date:
10/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  6485LICSW , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6485LICSW , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 6485LICSW , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 434M1SC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 434M2SC . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP27100 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6203572 . This is a "MEDICA/UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".