Individual
MARY KAY NIESSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
211 2ND AVE N, SARTELL, MN 56377-1728
(320) 253-8940
(320) 253-1846
Mailing address
PO BOX 2390, SAINT CLOUD, MN 56302-2390
(320) 650-1550
(320) 650-1528
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10428
MN
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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