Healthcare Provider Details

I. General information

NPI: 1316273584
Provider Name (Legal Business Name): LORRAINE V NJOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2009
Last Update Date: 02/10/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

IV. Provider business mailing address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2630
  • Fax: 507-455-8133
Mailing address:
  • Phone: 507-451-2630
  • Fax: 507-455-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09923202
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: