MEDICARE: VICTORIOUS HEART SERVICES

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	:	1780563528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORIOUS HEART SERVICES

Provider Business Mailing Address
First Line	:	3120 RIDGEWOOD RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3650
Country	:	US
Telephone Number	:	612-493-8710
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 RIDGEWOOD RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-3650
Country	:	US
Telephone Number	:	612-493-8710
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MISS NICOLE TERLOUW
Credential	:	MSW, LICSW
Telephone Number	:	612-493-8710

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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