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NPI Code Detail

MEDICARE: MS. ALICE BROWN L.I.C.S.W.

MEDICARE: MS. ALICE BROWN L.I.C.S.W.
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 Worker24001MN

General Provider Information

NPI Number : 1437541802
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALICE BROWN L.I.C.S.W.
Provider Business Mailing Address
First Line : 4826 CHICAGO AVE STE 105
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1055
Country : US
Telephone Number : 612-827-3028
Fax Number : 612-823-4993
Provider Business Practice Location Address
First Line : 4826 CHICAGO AVE STE 105
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1055
Country : US
Telephone Number : 612-827-3028
Fax Number : 612-823-4993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2015
Last Update Date : 02/23/2015

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