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NPI Code Detail

MEDICARE: MARY ALICE KALIL LISW

MEDICARE: MARY ALICE KALIL LISW
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
1104100000XSocial Worker3738MN

General Provider Information

NPI Number : 1932364221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ALICE KALIL LISW
Provider Business Mailing Address
First Line : 7701 W 13 1/2 ST
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55426-2001
Country : US
Telephone Number : 952-512-0876
Fax Number :
Provider Business Practice Location Address
First Line : 2450 26TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1245
Country : US
Telephone Number : 612-728-2455
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2008
Last Update Date : 07/25/2008

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Directions to “ MARY ALICE KALIL LISW” Practice Location

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