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General NPI Number Information
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NPI Number | 1952931586
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Entity Type | Individual
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Provider Name | CORIE STEWART MCKIBBEN MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/23/2020
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 10 N 1ST AVE E STE 202
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City | ELY
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State | MN
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Zip | 55731-1473
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Country | US
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Telephone | 218-216-8467
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Fax | 218-261-9083
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Provider Business Mailing Address
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Address Line | 1109 RINGROCK RD
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City | ELY
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State | MN
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Zip | 55731-8235
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Country | US
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Telephone | 218-216-8467
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Fax | 218-261-9083
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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 | 25428
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License Number State | MN
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