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NPI Code Detail

MEDICARE: JANET MARIE DENISON LICSW, LADC

MEDICARE:   JANET MARIE DENISON  LICSW, LADC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor302127MN
21041C0700XClinical Social Worker5524MN

General Provider Information

NPI Number : 1568639169
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANET MARIE DENISON LICSW, LADC
Provider Business Mailing Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-281-3940
Fax Number :
Provider Business Practice Location Address
First Line : 603 BRUCE ST
Second Line :
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-281-3940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2008
Last Update Date : 06/16/2011

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Directions to “ JANET MARIE DENISON LICSW, LADC” Practice Location

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