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NPI Code Detail

MEDICARE: MAI LOR MOUA

MEDICARE: MAI LOR MOUA
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 Worker26027MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126027OTHERMNLICSW LICENSE

General Provider Information

NPI Number : 1427513340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAI LOR MOUA
Provider Business Mailing Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2310
Fax Number : 651-280-3995
Provider Business Practice Location Address
First Line : 451 LEXINGTON PKWY N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4636
Country : US
Telephone Number : 651-280-2310
Fax Number : 651-280-3995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2019
Last Update Date : 03/12/2026

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Directions to “ MAI LOR MOUA ” Practice Location

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