MEDICARE: CAJETAN CHUKWUMA EGBUJOR 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	15624	MN

General Provider Information

NPI Number	:	1588714281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAJETAN CHUKWUMA EGBUJOR LICSW

Provider Business Mailing Address
First Line	:	8411 BRUNSWICK AVE N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2012
Country	:	US
Telephone Number	:	763-442-0622
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 E 38TH ST
Second Line	:	SUITE 228
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55409-1300
Country	:	US
Telephone Number	:	612-243-1600
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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