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NPI Code Detail

MEDICARE: MS. NANCY LEE KOLAAS LICSW

MEDICARE:  MS. NANCY LEE KOLAAS  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
1104100000XSocial Worker1444MN

General Provider Information

NPI Number : 1689723090
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NANCY LEE KOLAAS LICSW
Provider Business Mailing Address
First Line : 2116 CAMPUS DRIVE SE
Second Line :
City : ROCHESTER
State : MN
Zip : 55904
Country : US
Telephone Number : 507-287-2243
Fax Number : 507-287-2371
Provider Business Practice Location Address
First Line : 2116 CAMPUS DRIVE SE
Second Line :
City : ROCHESTER
State : MN
Zip : 55904
Country : US
Telephone Number : 507-287-2243
Fax Number : 507-287-2371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 07/08/2007

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