MEDICARE: WILLIAM JOHN KOSKI LISW

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
1	104100000X	Social Worker	7464	MN

General Provider Information

NPI Number	:	1336442805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM JOHN KOSKI LISW

Provider Business Mailing Address
First Line	:	5833 PECAN ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6689
Country	:	US
Telephone Number	:	651-277-4283
Fax Number	:	651-277-4284

Provider Business Practice Location Address
First Line	:	5833 PECAN ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6689
Country	:	US
Telephone Number	:	651-277-4283
Fax Number	:	651-277-4284

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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