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NPI Code Detail

MEDICARE: GINA LYNN MISIEWICZ LICSW

MEDICARE: GINA LYNN MISIEWICZ 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
11041S0200XSchool Social Worker21761MN
21041C0700XClinical Social Worker21761MN

General Provider Information

NPI Number : 1154957439
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA LYNN MISIEWICZ LICSW
Provider Business Mailing Address
First Line : 3300 OAKDALE AVE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2900
Country : US
Telephone Number : 763-581-5372
Fax Number :
Provider Business Practice Location Address
First Line : 3300 OAKDALE AVENUE N
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422
Country : US
Telephone Number : 763-581-5372
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2020
Last Update Date : 03/23/2026

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Directions to “ GINA LYNN MISIEWICZ LICSW” Practice Location

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