MEDICARE: MISS ELLIOTT MANAGO-LAWLER 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	101YM0800X	Mental Health Counselor	26467	MN

General Provider Information

NPI Number	:	1366086290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELLIOTT MANAGO-LAWLER LICSW

Provider Business Mailing Address
First Line	:	7600 PARKLAWN AVE STE 380
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 PARKLAWN AVE STE 380
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5156
Country	:	US
Telephone Number	:	612-203-2961
Fax Number	:	952-831-0033

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

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	05/08/2026

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Directions to “ MISS ELLIOTT MANAGO-LAWLER LICSW” Practice Location

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