MEDICARE: MR. MARK EDMUND LACHAPELLE MSW

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	967	MN

General Provider Information

NPI Number	:	1790797850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK EDMUND LACHAPELLE MSW

Provider Business Mailing Address
First Line	:	1660 HIGHWAY 100 S
Second Line	:	SUITE 334
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1529
Country	:	US
Telephone Number	:	952-928-8474
Fax Number	:	952-928-8532

Provider Business Practice Location Address
First Line	:	1660 HIGHWAY 100 S
Second Line	:	SUITE 334
City	:	SAINT LOUIS PARK
State	:	MN
Zip	:	55416-1529
Country	:	US
Telephone Number	:	952-928-8474
Fax Number	:	952-928-8532

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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