| Doctor Name: | TRACY KUPHAL-STRAND |
| NPI Number: | 1093179020 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 19381 |
| Business Practice Address: | 12915 63rd Ave N Maple Grove, MN - 553696001 |
| Business Phone Number: | 7633835800 |
| Business Fax Number: | |
| Mailing Address: | 8231 109th Pl N, CHAMPLIN |
| State: | MN |
| Postal Code: | 553163718 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/06/2016 |
| NPI Last Update Date: | 04/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 19381 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |