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NPI Code Detail

MEDICARE: CHRISTINE MARIE MANN MSW, LICSW, LADC

MEDICARE: CHRISTINE MARIE MANN MSW, LICSW, LADC
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 Worker21451MN

General Provider Information

NPI Number : 1295184562
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE MARIE MANN MSW, LICSW, LADC
Provider Business Mailing Address
First Line : 117 S SPRING ST
Second Line :
City : LUVERNE
State : MN
Zip : 56156-1916
Country : US
Telephone Number : 507-283-9511
Fax Number : 507-283-9514
Provider Business Practice Location Address
First Line : 117 S SPRING ST
Second Line :
City : LUVERNE
State : MN
Zip : 56156-1916
Country : US
Telephone Number : 507-283-9511
Fax Number : 507-283-9514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2016
Last Update Date : 06/08/2016

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Directions to “ CHRISTINE MARIE MANN MSW, LICSW, LADC” Practice Location

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