MEDICARE: LISA MARIE FEIKEMA

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

General Provider Information

NPI Number	:	1669260097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE FEIKEMA

Provider Business Mailing Address
First Line	:	1030 N 48TH AVE E
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-2458
Country	:	US
Telephone Number	:	412-738-4033
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 W SUPERIOR ST STE 911
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1717
Country	:	US
Telephone Number	:	412-738-4033
Fax Number	:

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

Provider Enumeration Date	:	04/26/2025
Last Update Date	:	04/26/2025

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Directions to “ LISA MARIE FEIKEMA ” Practice Location

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