MEDICARE: MARY ELLEN GRAMSE

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1588547160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN GRAMSE

Provider Business Mailing Address
First Line	:	39790 FAWN AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6164
Country	:	US
Telephone Number	:	651-808-3308
Fax Number	:

Provider Business Practice Location Address
First Line	:	39790 FAWN AVE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6164
Country	:	US
Telephone Number	:	651-808-3308
Fax Number	:

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

Provider Enumeration Date	:	07/30/2025
Last Update Date	:	07/30/2025

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Directions to “ MARY ELLEN GRAMSE ” Practice Location

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