MEDICARE: MRS. LORI ANN MITCHELL 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
1	1041C0700X	Clinical Social Worker	17526	MN

General Provider Information

NPI Number	:	1619132099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORI ANN MITCHELL LICSW

Provider Business Mailing Address
First Line	:	14800 WHITE OAK DR
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4155
Country	:	US
Telephone Number	:	952-891-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 LILAC DR N STE 151
Second Line	:
City	:	GOLDEN VALLEY
State	:	MN
Zip	:	55422-4536
Country	:	US
Telephone Number	:	763-525-9919
Fax Number	:

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	08/23/2019

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