MEDICARE: KENNETH RAYMOND TRAEN M.S.W., L.I.C.S.W.

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	15585	MN

General Provider Information

NPI Number	:	1134291024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH RAYMOND TRAEN M.S.W., L.I.C.S.W.

Provider Business Mailing Address
First Line	:	1976 MONTREAL AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2009
Country	:	US
Telephone Number	:	612-414-2533
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 SAINT CLAIR AVE
Second Line	:	SUITE 1E
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-1650
Country	:	US
Telephone Number	:	612-414-2533
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/30/2011

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