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NPI Code Detail

MEDICARE: ANN P GILLIGAN MA, LICSW

MEDICARE: ANN P GILLIGAN MA, 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
11041C0700XClinical Social Worker12884MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902807886
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANN P GILLIGAN MA, LICSW
Provider Business Mailing Address
First Line : 3548 BRYANT AVE S
Second Line : MINNEAPOLIS
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Provider Business Practice Location Address
First Line : 3548 BRYANT AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-4119
Country : US
Telephone Number : 612-822-8227
Fax Number : 612-825-4204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 07/08/2007

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Directions to “ ANN P GILLIGAN MA, LICSW” Practice Location

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