Provider Demographics
NPI:1962500777
Name:NEWLUND, ROSS A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:A
Last Name:NEWLUND
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18315 MINNETONKA BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2319
Mailing Address - Country:US
Mailing Address - Phone:763-357-8270
Mailing Address - Fax:612-677-6363
Practice Address - Street 1:1800 CHICAGO AVE. SO.
Practice Address - Street 2:MC 612
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1901
Practice Address - Country:US
Practice Address - Phone:612-879-3538
Practice Address - Fax:612-677-6363
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN141531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical