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General NPI Number Information
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NPI Number | 1992599898
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Entity Type | Individual
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Provider Name | CHELSEA RAE GRAN LEUTGEB MSW, LGSW
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Gender | Female
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 4135 RICHARD AVE STE 201
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City | DULUTH
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State | MN
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Zip | 55811-2979
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Country | US
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Telephone | 218-464-0908
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Fax |
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Provider Business Mailing Address
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Address Line | 704 MAPLE BEND DR
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City | DULUTH
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State | MN
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Zip | 55811-5032
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Country | US
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Telephone | 218-391-2516
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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 | 33536
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License Number State | MN
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