Individual
MARY BETH THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
207 AVENUE C, SUITE 202, CLOQUET, MN 55720-1584
(218) 655-3347
(218) 655-3390
Mailing address
207 AVENUE C, SUITE 202, CLOQUET, MN 55720-1584
(218) 655-3347
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12849
MN
1041C0700X
Clinical Social Worker
993074
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766160600
—
MN
01
—
800001494
MEDICARE
MN
Enumeration date
04/03/2007
Last updated
01/23/2009
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