Healthcare Provider Details

I. General information

NPI: 1174604730
Provider Name (Legal Business Name): LISA MARIE SILVESTRI-ADAMICH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35629 HILL DR
GRAND RAPIDS MN
55744-5296
US

IV. Provider business mailing address

3920 13TH AVE E SUITE 6
HIBBING MN
55746-3675
US

V. Phone/Fax

Practice location:
  • Phone: 218-259-9417
  • Fax:
Mailing address:
  • Phone: 218-263-7540
  • Fax: 866-732-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15120
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: