Provider Demographics
NPI:1164962692
Name:AXEN, EMILY (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:AXEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MCANDREWS RD W STE 124
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4432
Mailing Address - Country:US
Mailing Address - Phone:651-328-9831
Mailing Address - Fax:612-416-8143
Practice Address - Street 1:1500 MCANDREWS RD W STE 124
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4432
Practice Address - Country:US
Practice Address - Phone:651-328-9831
Practice Address - Fax:612-416-8143
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN245631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical