MEDICARE: JUNEAU RONNYE HILL LICSW

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	1041C0700X	Clinical Social Worker	18096	MN

General Provider Information

NPI Number	:	1063654598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNEAU RONNYE HILL LICSW

Provider Business Mailing Address
First Line	:	2800 FREEWAY BLVD STE 118
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	612-986-3836
Fax Number	:	763-561-1843

Provider Business Practice Location Address
First Line	:	2800 FREEWAY BLVD STE 118
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55430-1751
Country	:	US
Telephone Number	:	612-986-3836
Fax Number	:	757-937-0964

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	12/01/2020

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