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NPI Code Detail

MEDICARE: JUDITH PARR

MEDICARE: JUDITH PARR
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 Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1183357000OTHERMNMEDICAL ASSISTANCE

General Provider Information

NPI Number : 1245305994
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH PARR
Provider Business Mailing Address
First Line : 849 LINWOOD AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55105-3325
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2310
Fax Number : 651-280-3995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2006
Last Update Date : 04/28/2017

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