MEDICARE: MRS. HOLLY JEAN LOTT 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	14839	MN

General Provider Information

NPI Number	:	1760642458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY JEAN LOTT LICSW

Provider Business Mailing Address
First Line	:	2136 FORD PKWY # 5622
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2850
Country	:	US
Telephone Number	:	612-234-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 FORD PKWY # 5622
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-2850
Country	:	US
Telephone Number	:	612-234-1564
Fax Number	:

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

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/24/2026

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