Individual
MEGAN EISELT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5500 94TH AVE N, BROOKLYN PARK, MN 55443
(612) 274-7403
Mailing address
5500 94TH AVE N, BROOKLYN PARK, MN 55443-1992
(122) 747-4036
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24711
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275064461
—
MN
Enumeration date
03/21/2017
Last updated
07/09/2018
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