Healthcare Provider Details

I. General information

NPI: 1437159712
Provider Name (Legal Business Name): SCOTT M MORGAN L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 REED ST SUITE 115
MANKATO MN
56001-6410
US

IV. Provider business mailing address

PO BOX 125
EAGLE LAKE MN
56024-0125
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-4060
  • Fax: 507-625-3915
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116378
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier130980D113
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerUCARE OF MINNESOTA
# 2
IdentifierHP42080
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerHEALTH PARTNERS
# 3
Identifier415T2MO
Identifier TypeOTHER
Identifier StateMN
Identifier IssuerBLUE CROSS BLUE SHIELD
# 4
Identifier834629100
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: