MEDICARE: NICOLE RENE BISBEE 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
1	1041C0700X	Clinical Social Worker	30408	MN

General Provider Information

NPI Number	:	1518729144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RENE BISBEE MSW, LICSW

Provider Business Mailing Address
First Line	:	1551 PAYNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3218
Country	:	US
Telephone Number	:	763-780-3307
Fax Number	:	763-780-3306

Provider Business Practice Location Address
First Line	:	1551 PAYNE AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3218
Country	:	US
Telephone Number	:	763-780-3307
Fax Number	:	763-780-3306

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	10/12/2025

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