Healthcare Provider Details

I. General information

NPI: 1417528126
Provider Name (Legal Business Name): MELISSA PASCOE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 07/03/2021
Certification Date: 07/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4525 WHITE BEAR PKWY STE 119
WHITE BEAR LAKE MN
55110-7666
US

IV. Provider business mailing address

1681 DAYTON AVE APT 1
SAINT PAUL MN
55104-6189
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-9212
  • Fax:
Mailing address:
  • Phone: 612-404-8485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29313
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: