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NPI Code Detail

MEDICARE: TONYA ANN DOLLY LICSW

MEDICARE: TONYA ANN DOLLY 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 Worker16145MN

General Provider Information

NPI Number : 1164658860
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA ANN DOLLY LICSW
Provider Business Mailing Address
First Line : 703 THIELEN DR
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-9613
Country : US
Telephone Number : 763-515-4563
Fax Number : 763-497-0552
Provider Business Practice Location Address
First Line : 703 THIELEN DR
Second Line :
City : SAINT MICHAEL
State : MN
Zip : 55376-9613
Country : US
Telephone Number : 763-515-4563
Fax Number : 763-497-0552
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2009
Last Update Date : 03/08/2023

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Directions to “ TONYA ANN DOLLY LICSW” Practice Location

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