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General NPI Number Information
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NPI Number | 1356530224
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Entity Type | Organization
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Legal Business Name | THE MIDWEST TRAUMA CENTER AND FAMILY RESOURCES
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 7400 METRO BLVD STE 413
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City | EDINA
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State | MN
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Zip | 55439-2326
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Country | US
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Telephone | 218-310-2864
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Fax |
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Provider Business Mailing Address
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Address Line | 7400 METRO BLVD STE 413
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City | EDINA
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State | MN
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Zip | 55439-2326
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Country | US
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Telephone | 218-310-2864
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LORALEE ANN CARTER
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Credential | LICSW
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Telephone | 218-310-2864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15212
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License Number State | MN
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