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NPI Code Detail

MEDICARE: GRACE ELIZABETH ALLEN LICSW

MEDICARE: GRACE ELIZABETH ALLEN 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
11041C0700XClinical Social Worker30154MN

General Provider Information

NPI Number : 1093359812
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE ELIZABETH ALLEN LICSW
Provider Business Mailing Address
First Line : 343 WOODLAKE DR SE
Second Line :
City : ROCHESTER
State : MN
Zip : 55904-6242
Country : US
Telephone Number : 507-289-2089
Fax Number :
Provider Business Practice Location Address
First Line : 1620 GREENVIEW DR SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55902-4319
Country : US
Telephone Number : 507-289-2089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2019
Last Update Date : 09/14/2023

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