MEDICARE: ERIN MARGARET PATCH LSW

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	104100000X	Social Worker	20495	MN

General Provider Information

NPI Number	:	1689983322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MARGARET PATCH LSW

Provider Business Mailing Address
First Line	:	15 1/2 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1816
Country	:	US
Telephone Number	:	218-254-4192
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 1/2 W LAKE ST
Second Line	:
City	:	CHISHOLM
State	:	MN
Zip	:	55719-1816
Country	:	US
Telephone Number	:	218-254-4192
Fax Number	:

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	09/29/2010

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Directions to “ ERIN MARGARET PATCH LSW” Practice Location

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