MEDICARE: MRS. NICOLE S. UZENDOSKI MSW, 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	104100000X	Social Worker	17773	MN

General Provider Information

NPI Number	:	1336280619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE S. UZENDOSKI MSW, LICSW

Provider Business Mailing Address
First Line	:	1061 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3002
Country	:	US
Telephone Number	:	612-644-0415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 GRAND AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3002
Country	:	US
Telephone Number	:	651-212-4920
Fax Number	:

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	04/01/2015

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