Provider Demographics
NPI:1164700977
Name:POWELL, CINDY L (LICSW)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:POWELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-3710
Mailing Address - Country:US
Mailing Address - Phone:507-328-7229
Mailing Address - Fax:507-328-7952
Practice Address - Street 1:151 4TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-3710
Practice Address - Country:US
Practice Address - Phone:507-328-7229
Practice Address - Fax:507-328-7952
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN140481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical