MEDICARE: LINDA CHEREK 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	14355	MN
2	163W00000X	Registered Nurse	R0679334	MN

General Provider Information

NPI Number	:	1659477784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA CHEREK LICSW

Provider Business Mailing Address
First Line	:	BIRCH LAKE PROFESSIONAL BUILDING 1310 HWY 96
Second Line	:	SUITE 200
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-7606
Country	:	US
Telephone Number	:	651-426-3071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 HIGHWAY 96 E
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55110-3624
Country	:	US
Telephone Number	:	651-426-3071
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	08/03/2007

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Directions to “ LINDA CHEREK LICSW” Practice Location

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