Individual
MARY JO MLEZIVA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
153 CESAR CHAVEZ ST, SAINT PAUL, MN 55107-2226
(651) 222-1816
(651) 602-7517
Mailing address
2120 WISCONSIN AVE N, GOLDEN VALLEY, MN 55427-3365
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4549
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141951
UCARE
MN
01
—
53M33ML
BCBS
MN
01
—
6259777
MEDICA
MN
01
—
923911025981
PREFERRED ONE
MN
01
—
HP30940
HEALTH PARTNERS
MN
Enumeration date
03/29/2006
Last updated
07/08/2007
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