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NPI Code Detail

MEDICARE: MRS. SHANNON LEA KRONLUND LICSW

MEDICARE: MRS. SHANNON LEA KRONLUND 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 Worker15947MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
126023OTHERNDBCBS OF ND
2HP55669OTHERHEALTH PARTNERS
31044495OTHERPREFERRED ONE
4136769OTHERMNUCARE MINNESOTA
5198P8KROTHERMNBCBS OF MN

General Provider Information

NPI Number : 1598734147
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON LEA KRONLUND LICSW
Provider Business Mailing Address
First Line : 603 BRUCE ST
Second Line : PO BOX 603
City : CROOKSTON
State : MN
Zip : 56716-2914
Country : US
Telephone Number : 218-281-3940
Fax Number : 218-281-6261
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 : 218-281-6261
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. SHANNON LEA KRONLUND LICSW” Practice Location

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