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NPI Code Detail

MEDICARE: MS. TRICIA JEANNE HELLERUD LICSW

MEDICARE: MS. TRICIA JEANNE HELLERUD 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 Worker17210MN

General Provider Information

NPI Number : 1205025244
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TRICIA JEANNE HELLERUD LICSW
Provider Business Mailing Address
First Line : 39498 270TH AVE SW
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-8719
Country : US
Telephone Number : 218-289-3642
Fax Number : 218-281-3940
Provider Business Practice Location Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-281-3940
Fax Number : 218-281-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2007
Last Update Date : 10/16/2007

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Directions to “ MS. TRICIA JEANNE HELLERUD LICSW” Practice Location

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