MEDICARE: MS. BETH ANN NELSON MSW 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	04313	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6207092	OTHER		MEDICA
2	40B92NE	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114049772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETH ANN NELSON MSW LICSW

Provider Business Mailing Address
First Line	:	4660 SLATER ROAD
Second Line	:	SUITE 210
City	:	EAGAN
State	:	MN
Zip	:	55122-4055
Country	:	US
Telephone Number	:	651-681-8615
Fax Number	:	651-683-0057

Provider Business Practice Location Address
First Line	:	4660 SLATER ROAD
Second Line	:	SUITE 210
City	:	EAGAN
State	:	MN
Zip	:	55122-4055
Country	:	US
Telephone Number	:	651-681-8615
Fax Number	:	651-683-0057

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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