Provider Demographics
NPI:1295403681
Name:ERSPAMER, ANGELA DAWN (LPCC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:ERSPAMER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15544 CORNELL TRL
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4684
Mailing Address - Country:US
Mailing Address - Phone:952-486-1949
Mailing Address - Fax:
Practice Address - Street 1:507 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2756
Practice Address - Country:US
Practice Address - Phone:507-301-3412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02944101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC02944OtherBOARD OF BEHAVIORAL HEALTH AND THERAPY