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NPI Code Detail

MEDICARE: JON STUMBRAS LICSW

MEDICARE: JON STUMBRAS 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 Worker792MN

General Provider Information

NPI Number : 1295833150
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON STUMBRAS LICSW
Provider Business Mailing Address
First Line : 1121 E 46TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3562
Country : US
Telephone Number : 612-827-9304
Fax Number :
Provider Business Practice Location Address
First Line : 1121 E 46TH ST
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3562
Country : US
Telephone Number : 612-827-9304
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 09/07/2023

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Directions to “ JON STUMBRAS LICSW” Practice Location

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