Healthcare Provider Details

I. General information

NPI: 1316225527
Provider Name (Legal Business Name): LINH SCALLY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2011
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 NE 4TH ST
GRAND RAPIDS MN
55744-3106
US

IV. Provider business mailing address

2306 MCKINNEY LAKE RD
GRAND RAPIDS MN
55744-4323
US

V. Phone/Fax

Practice location:
  • Phone: 218-398-0742
  • Fax:
Mailing address:
  • Phone: 218-398-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20023
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: