MEDICARE: HAILEY JO MORK

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	225A00000X	Music Therapist	541990	MN

General Provider Information

NPI Number	:	1326617135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY JO MORK

Provider Business Mailing Address
First Line	:	1337 ALAMEDA ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4115
Country	:	US
Telephone Number	:	320-226-3157
Fax Number	:

Provider Business Practice Location Address
First Line	:	17645 JUNIPER PATH STE 205
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-7491
Country	:	US
Telephone Number	:	507-581-2957
Fax Number	:

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/24/2021

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Directions to “ HAILEY JO MORK ” Practice Location

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