Provider Demographics
NPI:1821246588
Name:LEWIS, GEORGEANNA INGERSOLL (MSW)
Entity Type:Individual
Prefix:MS
First Name:GEORGEANNA
Middle Name:INGERSOLL
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3712
Mailing Address - Country:US
Mailing Address - Phone:612-239-2796
Mailing Address - Fax:612-971-3874
Practice Address - Street 1:3217 HENNEPIN AVE STE 5
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4695
Practice Address - Country:US
Practice Address - Phone:612-239-2796
Practice Address - Fax:888-971-3874
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical