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General NPI Number Information
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NPI Number | 1093849622
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Entity Type | Individual
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Provider Name | THOMAS EDWARD MONSEN MSW LICSW
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Gender | Male
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Dates
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Enumeration Date | 03/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 504 INDUSTRIAL BOULEVARD
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City | WACONIA
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State | MN
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Zip | 56387
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Country | US
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Telephone | 952-442-3158
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Fax | 952-442-3174
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Provider Business Mailing Address
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Address Line | 600 EAST FOURTH STREET
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-361-1640
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Fax | 952-361-1660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LICSW15255
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License Number State | MN
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