Provider Demographics
NPI:1083350557
Name:ENGE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:ENGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 DEAN LAKES BLVD
Mailing Address - Street 2:UNIT 160
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2863
Mailing Address - Country:US
Mailing Address - Phone:612-416-1301
Mailing Address - Fax:
Practice Address - Street 1:4201 DEAN LAKES BLVD
Practice Address - Street 2:UNIT 160
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:612-416-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician