Individual
MS. LISA D PORTINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1854 GRAND AVE, SAINT PAUL, MN 55105-1403
(651) 702-6539
Mailing address
3516 LEXINGTON AVE S APT 7, EAGAN, MN 55123-1126
(651) 686-5285
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12440
MN
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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