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NPI Code Detail

MEDICARE: CARLA SANDAHL MORTENSEN MSW LICSW

MEDICARE: CARLA SANDAHL MORTENSEN MSW 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
11041C0700XClinical Social Worker4547MN

General Provider Information

NPI Number : 1497783658
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA SANDAHL MORTENSEN MSW LICSW
Provider Business Mailing Address
First Line : 3548 BRYANT AVE S
Second Line : THE MENTAL HEALTH COLLECTIVE
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Provider Business Practice Location Address
First Line : 3548 BRYANT AVE S
Second Line : THE MENTAL HEALTH COLLECTIVE
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 07/08/2007

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