Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 15962 | MN |
NPI | 1003261470 |
---|---|
Provider Name | Laura Maxwell |
First Address | Hibbing, MN 55746-2341 |
Second Address | Hibbing, MN 55746-2341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 04/05/2016 |