Provider Demographics
NPI:1083017040
Name:LANE, ABIGAIL (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:SIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 DECATUR AVE N STE 109
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4363
Mailing Address - Country:US
Mailing Address - Phone:763-227-2054
Mailing Address - Fax:
Practice Address - Street 1:5910 SHINGLE CREEK PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2322
Practice Address - Country:US
Practice Address - Phone:763-569-5200
Practice Address - Fax:763-569-5201
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN212491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical