MEDICARE: MIKAELA WARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	CC05492	MN

General Provider Information

NPI Number	:	1053269779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAELA WARD

Provider Business Mailing Address
First Line	:	9001 E BLOOMINGTON FWY
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-3435
Country	:	US
Telephone Number	:	763-777-9499
Fax Number	:	763-373-9463

Provider Business Practice Location Address
First Line	:	9001 E BLOOMINGTON FWY
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-3435
Country	:	US
Telephone Number	:	763-777-9499
Fax Number	:	763-373-9463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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