Provider Demographics
NPI:1427415082
Name:TOBECK, NATALIE ANN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANN
Last Name:TOBECK
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:ANN
Other - Last Name:BOISVERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:3116 COUNTY ROAD 30 SE
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8135
Mailing Address - Country:US
Mailing Address - Phone:612-889-6961
Mailing Address - Fax:
Practice Address - Street 1:3100 W LAKE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4527
Practice Address - Country:US
Practice Address - Phone:612-925-6033
Practice Address - Fax:612-925-8496
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH100321482Medicare PIN