MEDICARE: LEE START MSW, LICSW, LADC

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	104100000X	Social Worker		MN

General Provider Information

NPI Number	:	1912523184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE START MSW, LICSW, LADC

Provider Business Mailing Address
First Line	:	4332 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-3226
Country	:	US
Telephone Number	:	612-227-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	2303 WYCLIFF ST STE 315
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1272
Country	:	US
Telephone Number	:	651-419-1086
Fax Number	:

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

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	08/04/2025

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