Provider Demographics
NPI:1205858735
Name:MAU, ELIZABETH (MS, LP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:MAU
Suffix:
Gender:F
Credentials:MS, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5343 HEATH AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-3055
Mailing Address - Country:US
Mailing Address - Phone:651-779-9955
Mailing Address - Fax:
Practice Address - Street 1:6381 OSGOOD AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6118
Practice Address - Country:US
Practice Address - Phone:651-430-2212
Practice Address - Fax:651-430-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3514103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist