MEDICARE: KASSIA COLEMAN 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
1	1041C0700X	Clinical Social Worker	20773	MN

General Provider Information

NPI Number	:	1932750098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASSIA COLEMAN LICSW

Provider Business Mailing Address
First Line	:	6738 MEADOW GRASS LN S
Second Line	:
City	:	COTTAGE GROVE
State	:	MN
Zip	:	55016-1000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 UNIVERSITY AVE W STE 219
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2892
Country	:	US
Telephone Number	:	612-501-1888
Fax Number	:

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

Provider Enumeration Date	:	09/20/2019
Last Update Date	:	09/25/2024

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Directions to “ KASSIA COLEMAN LICSW” Practice Location

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