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General NPI Number Information
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NPI Number | 1134946759
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Entity Type | Individual
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Provider Name | KESHA ALICIA ROYAL GUTE MSW, LGSW
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Gender | Female
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Dates
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Enumeration Date | 09/24/2024
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | PEOPLE FIRST CLINIC PLLC 652 BIELENBERG DRIVE SUITE 202
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-401-2134
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Fax |
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Provider Business Mailing Address
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Address Line | 3257 RUSSELL AVE N STE 202
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City | MINNEAPOLIS
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State | MN
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Zip | 55412-2234
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Country | US
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Telephone | 651-401-2134
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Fax |
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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 | 30028
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License Number State | MN
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