Healthcare Provider Details

I. General information

NPI: 1255354155
Provider Name (Legal Business Name): LINDA BARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 4TH ST N
CANNON FALLS MN
55009-2036
US

IV. Provider business mailing address

403 EVERGREEN DR E
CANNON FALLS MN
55009-1229
US

V. Phone/Fax

Practice location:
  • Phone: 515-250-4424
  • Fax:
Mailing address:
  • Phone: 515-250-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20257
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: