Provider Demographics
NPI:1639796188
Name:HINZ, LORI JANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JANE
Last Name:HINZ
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 1:610 OPPERMAN DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1340
Mailing Address - Country:US
Mailing Address - Phone:612-656-0400
Mailing Address - Fax:
Practice Address - Street 1:610 OPPERMAN DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-1340
Practice Address - Country:US
Practice Address - Phone:612-656-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN151221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical