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NPI Code Detail

MEDICARE: KARYN MARIE ERTEL LICSW

MEDICARE: KARYN MARIE ERTEL 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 Worker
21041C0700XClinical Social Worker16072MN

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 : 1932184504
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARYN MARIE ERTEL LICSW
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 763-350-6371
Fax Number :
Provider Business Practice Location Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 763-350-6371
Fax Number : 763-263-5927
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 01/29/2018

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Directions to “ KARYN MARIE ERTEL LICSW” Practice Location

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