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NPI Code Detail

MEDICARE: REBECCA ANN MACIEJ LICSW

MEDICARE: REBECCA ANN MACIEJ 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 Worker18532MN

General Provider Information

NPI Number : 1558630079
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBECCA ANN MACIEJ LICSW
Provider Business Mailing Address
First Line : 1053 KEEFE ST
Second Line :
City : EAGAN
State : MN
Zip : 55121-1410
Country : US
Telephone Number : 651-645-4439
Fax Number :
Provider Business Practice Location Address
First Line : 317 YORK AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55130-4039
Country : US
Telephone Number : 651-774-0011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2011
Last Update Date : 12/29/2011

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Directions to “ REBECCA ANN MACIEJ LICSW” Practice Location

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