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NPI Code Detail

MEDICARE: MS. ELLEN THOMPSON LUEPKER MSW

MEDICARE:  MS. ELLEN THOMPSON LUEPKER  MSW
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
11041C0700XClinical Social Worker03753MN

General Provider Information

NPI Number : 1922122258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ELLEN THOMPSON LUEPKER MSW
Provider Business Mailing Address
First Line : 821 RAYMOND AVE
Second Line : STE 440
City : SAINT PAUL
State : MN
Zip : 55114-1525
Country : US
Telephone Number : 651-642-9317
Fax Number : 651-642-1908
Provider Business Practice Location Address
First Line : 821 RAYMOND AVE
Second Line : STE 440
City : SAINT PAUL
State : MN
Zip : 55114-1525
Country : US
Telephone Number : 651-642-9317
Fax Number : 651-642-1908
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 01/02/2020

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Directions to “ MS. ELLEN THOMPSON LUEPKER MSW” Practice Location

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