MEDICARE: LUCY MORREIM HARGROVE LISW

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	LISW4994	MN

General Provider Information

NPI Number	:	1407151954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCY MORREIM HARGROVE LISW

Provider Business Mailing Address
First Line	:	3205 WALDEN WAY
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-9058
Country	:	US
Telephone Number	:	320-251-2728
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 WALDEN WAY
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-9058
Country	:	US
Telephone Number	:	320-251-2728
Fax Number	:

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

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/13/2011

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