Individual
MARY ELLEN LOUISE VIDOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1310 HIGHWAY 96 E, SUITE 200, WHITE BEAR LAKE, MN 55110-3624
(651) 426-3071
Mailing address
1310 HIGHWAY 96 E, SUITE 200, WHITE BEAR LAKE, MN 55110-3624
(651) 426-3071
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9587
MN
Other
Enumeration date
09/20/2006
Last updated
04/10/2008
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