| Doctor Name: | MRS. GRETCHEN SUZANNE KIRVIDA |
| NPI Number: | 1215097928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 3068 |
| Business Practice Address: | 882 Sw 15th Street Forest Lake, MN - 55025 |
| Business Phone Number: | 6514642194 |
| Business Fax Number: | 6514645744 |
| Mailing Address: | Po Box 397, CENTER CITY |
| State: | MN |
| Postal Code: | 55012 |
| Phone Number: | 6512575399 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 3068 |
| 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 |