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NPI Code Detail

MEDICARE: MRS. STEPHANIE A BUMGARDNER M.S.W., L.I.C.S.W

MEDICARE: MRS. STEPHANIE A BUMGARDNER M.S.W., L.I.C.S.W
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
1101YM0800XMental Health Counselor16568MN
21041C0700XClinical Social Worker16568MN

General Provider Information

NPI Number : 1306080197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. STEPHANIE A BUMGARDNER M.S.W., L.I.C.S.W
Provider Business Mailing Address
First Line : 1526 30TH ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4140
Country : US
Telephone Number : 218-751-0887
Fax Number : 218-759-4807
Provider Business Practice Location Address
First Line : 1526 30TH ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-4140
Country : US
Telephone Number : 218-751-0887
Fax Number : 218-759-4807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2009
Last Update Date : 03/30/2022

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