Individual
LISA MARIE POWERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
1321 13TH ST N, SAINT CLOUD, MN 56303-2613
(320) 252-5010
Mailing address
407 WASHINGTON ST, MONTICELLO, MN 55362-8815
(763) 271-5325
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
14368
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199711400
—
MN
Enumeration date
10/20/2006
Last updated
12/02/2016
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