MEDICARE: VERONICA RIVERA ARTEAGA

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
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1679239966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA RIVERA ARTEAGA

Provider Business Mailing Address
First Line	:	3200 SPRUCE TRL SW
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-2735
Country	:	US
Telephone Number	:	952-715-1994
Fax Number	:

Provider Business Practice Location Address
First Line	:	3612 BLOOMINGTON AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-2817
Country	:	US
Telephone Number	:	612-462-3812
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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