Healthcare Provider Details

I. General information

NPI: 1437150885
Provider Name (Legal Business Name): CLARA ELIZABETH CASE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 PILOT KNOB RD STE 190
MENDOTA HEIGHTS MN
55120
US

IV. Provider business mailing address

2520 PILOT KNOB RD STE 190
MENDOTA HEIGHTS MN
55120
US

V. Phone/Fax

Practice location:
  • Phone: 651-452-1500
  • Fax: 651-452-1502
Mailing address:
  • Phone: 651-452-1500
  • Fax: 651-452-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC LICSW 11315
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: