Individual
MS. LAURA ELIZABETH MCKIBBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1880 AUSTIN RD, SUITE 2 MENTAL HEALTH PROFESSIONALS, OWATONNA, MN 55060-4402
(507) 446-8123
(507) 446-0600
Mailing address
1880 AUSTIN RD, SUITE 2 MENTAL HEALTH PROFESSIONALS, OWATONNA, MN 55060-4402
(507) 446-8123
(507) 446-0600
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
13543
MN
1041C0700X
Clinical Social Worker
00809
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51940
WELLMARK
IA
01
—
I1488
MEDICARE INDIVIDUAL PROVI
—
Enumeration date
08/25/2006
Last updated
09/25/2007
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