MEDICARE: JANELLE HINCHLEY 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	10027	MN

General Provider Information

NPI Number	:	1427181437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANELLE HINCHLEY LICSW

Provider Business Mailing Address
First Line	:	PO BOX 2390
Second Line	:
City	:	SAINT CLOUD
State	:	MN
Zip	:	56302-2390
Country	:	US
Telephone Number	:	320-650-1550
Fax Number	:	320-650-1528

Provider Business Practice Location Address
First Line	:	157 ROOSEVELT RD
Second Line	:	SUITE 300
City	:	SAINT CLOUD
State	:	MN
Zip	:	56301-5478
Country	:	US
Telephone Number	:	320-240-3324
Fax Number	:	320-240-3339

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	07/08/2007

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