MEDICARE: DANA LOUISE GARBERG 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	19954	MN

General Provider Information

NPI Number	:	1982977898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA LOUISE GARBERG LICSW

Provider Business Mailing Address
First Line	:	205 W 2ND ST STE 300
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1928
Country	:	US
Telephone Number	:	218-228-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W 2ND ST STE 300
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1928
Country	:	US
Telephone Number	:	218-228-0035
Fax Number	:

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

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	03/07/2016

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