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NPI Code Detail

MEDICARE: ANN MARIE GULLICKSON MSW, LGSW

MEDICARE: ANN MARIE GULLICKSON MSW, LGSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1386423796
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN MARIE GULLICKSON MSW, LGSW
Provider Business Mailing Address
First Line : 4551 COLLEGE VIEW RD E
Second Line :
City : ROCHESTER
State : MN
Zip : 55904-7510
Country : US
Telephone Number : 507-218-6393
Fax Number :
Provider Business Practice Location Address
First Line : 3253 19TH ST NW STE 1
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-6794
Country : US
Telephone Number : 507-218-6393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2023
Last Update Date : 09/25/2023

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