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NPI Code Detail

MEDICARE: JODY KAY DUNLAP LICSW

MEDICARE: JODY KAY DUNLAP LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker8183MN

General Provider Information

NPI Number : 1073593612
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODY KAY DUNLAP LICSW
Provider Business Mailing Address
First Line : 1875 NORTHWESTERN AVE S
Second Line :
City : STILLWATER
State : MN
Zip : 55082-7534
Country : US
Telephone Number : 651-439-4840
Fax Number : 651-439-4894
Provider Business Practice Location Address
First Line : 1875 NORTHWESTERN AVE S
Second Line :
City : STILLWATER
State : MN
Zip : 55082-7534
Country : US
Telephone Number : 651-439-4840
Fax Number : 651-439-4894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 07/08/2007

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Directions to “ JODY KAY DUNLAP LICSW” Practice Location

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