MEDICARE: MS. RENEE M. LEVESQUE M.S.W., 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
1	1041C0700X	Clinical Social Worker	14676	FM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1306963798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENEE M. LEVESQUE M.S.W., LICSW

Provider Business Mailing Address
First Line	:	130 WABASHA ST S STE 90
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-1819
Country	:	US
Telephone Number	:	651-925-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 WABASHA ST S STE 90
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55107-1819
Country	:	US
Telephone Number	:	651-925-8453
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/18/2019

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