Provider Information for 1225883150
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DEANA MIKOLICH LGSW
Sex: Female
NPI: 1225883150
Last Updated: 2024-04-23
Certification Date: 2024-04-23
Certification Date: 2024-04-23
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225883150 | ||||||||
| Enumeration Date | 2024-04-23 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3902 W LONG LAKE RD EVELETH, MN 55734-4130 United States Phone: 925-303-5138 | Fax: | ||||||||
| Primary Practice Address | 227 MCKINLEY AVE EVELETH, MN 55734-1606 United States Phone: 925-303-5138 | Fax: | ||||||||
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