Healthcare Provider Details

I. General information

NPI: 1932037686
Provider Name (Legal Business Name): MARY MCPHEE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 BARRY AVE N
WAYZATA MN
55391-1012
US

IV. Provider business mailing address

13305 12TH AVE N
PLYMOUTH MN
55441-4527
US

V. Phone/Fax

Practice location:
  • Phone: 763-745-6448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number23504
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: