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NPI Code Detail

MEDICARE: MR. ROSS A. NEWLUND LICSW

MEDICARE: MR. ROSS A. NEWLUND 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
11041C0700XClinical Social Worker14153MN

General Provider Information

NPI Number : 1962500777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROSS A. NEWLUND LICSW
Provider Business Mailing Address
First Line : 18315 MINNETONKA BLVD STE 140
Second Line :
City : WAYZATA
State : MN
Zip : 55391-2319
Country : US
Telephone Number : 763-357-8270
Fax Number : 612-677-6363
Provider Business Practice Location Address
First Line : 1800 CHICAGO AVE. SO.
Second Line : MC 612
City : MINNEAPOLIS
State : MN
Zip : 55404-1901
Country : US
Telephone Number : 612-879-3538
Fax Number : 612-677-6363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 12/23/2023

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