Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 21133 | MN |
N | 1041C0700X | Clinical Social Worker | 2113 | MN |
NPI | 1003213299 |
---|---|
Provider Name | Nathan Foote |
First Address | Minneapolis, MN 55405-1430 |
Second Address | Minneapolis, MN 55405-1430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 31/12/2020 |