MEDICARE: MS. CATHERINE MARIA STRUB MSW 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	15311LICSW	MN

General Provider Information

NPI Number	:	1760594535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE MARIA STRUB MSW LICSW

Provider Business Mailing Address
First Line	:	4432 CHICAGO AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-871-0118
Fax Number	:	612-870-2403

Provider Business Practice Location Address
First Line	:	4432 CHICAGO AVENUE SOUTH
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407
Country	:	US
Telephone Number	:	612-871-0118
Fax Number	:	612-870-2403

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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