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General NPI Number Information
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NPI Number | 1548718869
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Entity Type | Individual
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Provider Name | ELEANOR PORTER-NELSON MSW
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Gender | Female
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 2136 FORD PKWY # 5294
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 612-467-9924
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Fax | 612-234-4261
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Provider Business Mailing Address
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Address Line | 2136 FORD PKWY # 5294
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City | SAINT PAUL
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State | MN
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Zip | 55116-2850
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Country | US
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Telephone | 612-467-9924
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Fax | 612-234-4261
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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 | 26663
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.018524
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License Number State | IL
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