MEDICARE: KAITLIN EMMA FOSS MSW, 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
1	1041C0700X	Clinical Social Worker	26376	MN

General Provider Information

NPI Number	:	1548786486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN EMMA FOSS MSW, LICSW

Provider Business Mailing Address
First Line	:	1702 MILLER TRUNK HWY STE 209
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-524-8889
Fax Number	:	218-524-8890

Provider Business Practice Location Address
First Line	:	1702 MILLER TRUNK HWY STE 209
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55811-4448
Country	:	US
Telephone Number	:	218-524-8889
Fax Number	:	218-524-8890

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	04/16/2022

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