MEDICARE: WATERMAN COUNSELING, LLC

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

General Provider Information

NPI Number	:	1972264471
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATERMAN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	600 E SUPERIOR ST STE 404
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2237
Country	:	US
Telephone Number	:	218-302-5096
Fax Number	:	218-520-1789

Provider Business Practice Location Address
First Line	:	600 E SUPERIOR ST STE 404
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2237
Country	:	US
Telephone Number	:	218-302-5096
Fax Number	:	218-520-1789

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MRS. KARI A LOISEL
Credential	:
Telephone Number	:	218-355-0896

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	02/12/2026

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