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NPI Code Detail

MEDICARE: JASON CARL MERGEN MSW, LGSW

MEDICARE: JASON CARL MERGEN MSW, LGSW
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
1104100000XSocial Worker18246MN

General Provider Information

NPI Number : 1760507818
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON CARL MERGEN MSW, LGSW
Provider Business Mailing Address
First Line : 19241 EBONY RD
Second Line :
City : OSAKIS
State : MN
Zip : 56360-4845
Country : US
Telephone Number : 320-815-1077
Fax Number :
Provider Business Practice Location Address
First Line : 222 9TH AVE W
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-2221
Country : US
Telephone Number : 320-763-3912
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 07/08/2007

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