MEDICARE: BARBARA ANN FLO L.I.C.S.W.

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	3961	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41-0693906	OTHER	MN	EMPLOYER I.D.

General Provider Information

NPI Number	:	1811052566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA ANN FLO L.I.C.S.W.

Provider Business Mailing Address
First Line	:	855 SUNRISE AVE
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-5424
Country	:	US
Telephone Number	:	651-491-2358
Fax Number	:	651-439-1799

Provider Business Practice Location Address
First Line	:	1605 EUSTIS ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55108-1219
Country	:	US
Telephone Number	:	651-635-0477
Fax Number	:	651-635-0454

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

Provider Enumeration Date	:	12/23/2006
Last Update Date	:	07/08/2007

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