MEDICARE: MS. CLARA ELIZABETH CASE 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	MC LICSW 11315	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1042826	OTHER	MN	PREFERRED ONE
2	548T9CA	OTHER	MN	BLUECROSS BLUESHIELD
3	HP18896	OTHER	MN	HEALTH PARTNERS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	6256242	OTHER	MN	UBH-MEDICA

General Provider Information

NPI Number	:	1437150885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CLARA ELIZABETH CASE LICSW

Provider Business Mailing Address
First Line	:	2520 PILOT KNOB RD
Second Line	:	STE 190
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120
Country	:	US
Telephone Number	:	651-452-1500
Fax Number	:	651-452-1502

Provider Business Practice Location Address
First Line	:	2520 PILOT KNOB RD
Second Line	:	STE 190
City	:	MENDOTA HEIGHTS
State	:	MN
Zip	:	55120
Country	:	US
Telephone Number	:	651-452-1500
Fax Number	:	651-452-1502

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/19/2023

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