MEDICARE: PATRICIA KATHLEEN THURMER 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	20274	MN

General Provider Information

NPI Number	:	1790349785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KATHLEEN THURMER MSW, LICSW

Provider Business Mailing Address
First Line	:	5540 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3069
Country	:	US
Telephone Number	:	763-780-3036
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-3069
Country	:	US
Telephone Number	:	763-780-3036
Fax Number	:

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

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	04/25/2019

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