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Organization
PPSM
Active
Organization
PPSM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE UZENDOSKI (LICSW)
(612) 644-0415
Entity
Organization
Contact information
Practice address
1061 GRAND AVE, SAINT PAUL, MN 55105-3002
(651) 212-4920
Mailing address
1061 GRAND AVE, SAINT PAUL, MN 55105-3002
(651) 212-4920
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
17773
MN
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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