MEDICARE: HARRIET ADELE KOHEN MSW

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	14406	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88G08KO	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1528149879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRIET ADELE KOHEN MSW

Provider Business Mailing Address
First Line	:	10505 WAYZATA BLVD
Second Line	:	SUITE #200
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1502
Country	:	US
Telephone Number	:	763-545-8489
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 WAYZATA BLVD
Second Line	:	SUITE #200
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1502
Country	:	US
Telephone Number	:	763-545-8489
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/10/2013

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