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General NPI Number Information
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NPI Number | 1366539868
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Entity Type | Individual
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Provider Name | LINDA CHLECQ-LYSAGHT MSW, LICSW, ACSW
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 113 COMANCHE RD MHC 88 FM
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City | FORT MEADE
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State | SD
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Zip | 57741-1002
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Country | US
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Telephone | 605-490-2404
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 320
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City | FORT MEADE
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State | SD
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Zip | 57741-0320
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Country | US
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Telephone | 605-490-2404
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5387
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License Number State | MN
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