MEDICARE: ELEANOR PORTER-NELSON 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	26663	MN
2	1041C0700X	Clinical Social Worker	149.018524	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548718869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR PORTER-NELSON MSW

Provider Business Mailing Address
First Line	:	2136 FORD PKWY # 5294
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2850
Country	:	US
Telephone Number	:	612-467-9924
Fax Number	:	612-234-4261

Provider Business Practice Location Address
First Line	:	2136 FORD PKWY # 5294
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2850
Country	:	US
Telephone Number	:	612-467-9924
Fax Number	:	612-234-4261

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

Provider Enumeration Date	:	09/15/2016
Last Update Date	:	08/29/2022

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