MEDICARE: KARI LEWIS 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	20514	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20514	OTHER	MN	LICSW

General Provider Information

NPI Number	:	1659747145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI LEWIS LICSW

Provider Business Mailing Address
First Line	:	1200 2ND AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-2513
Country	:	US
Telephone Number	:	612-204-8500
Fax Number	:

Provider Business Practice Location Address
First Line	:	932 E 34TH ST
Second Line	:
City	:	MPLS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-204-8250
Fax Number	:

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

Provider Enumeration Date	:	08/19/2015
Last Update Date	:	08/19/2015

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