Provider Demographics
NPI:1043378573
Name:ROSSING, STEPHANIE KEEFFE (LMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KEEFFE
Last Name:ROSSING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 HAMILTON LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2345
Mailing Address - Country:US
Mailing Address - Phone:763-286-4257
Mailing Address - Fax:763-432-7424
Practice Address - Street 1:12760 ABERDEEN ST NE
Practice Address - Street 2:SUITE 205
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5845
Practice Address - Country:US
Practice Address - Phone:763-286-4257
Practice Address - Fax:763-432-7424
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1185106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1043378573Medicaid