MEDICARE: HEATHER YOUNGLOVE

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	15453	MN

General Provider Information

NPI Number	:	1154866804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER YOUNGLOVE

Provider Business Mailing Address
First Line	:	P.O. BOX 43, MAIL ROUTE 10202
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-0043
Country	:	US
Telephone Number	:	612-863-8511
Fax Number	:	612-863-8516

Provider Business Practice Location Address
First Line	:	2925 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1301
Country	:	US
Telephone Number	:	612-863-8511
Fax Number	:	612-863-8516

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

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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Directions to “ HEATHER YOUNGLOVE ” Practice Location

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