Provider Demographics
NPI:1316218118
Name:BEASLEY, ABIGAIL (LICSW)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 BOONE AVE N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4563
Mailing Address - Country:US
Mailing Address - Phone:763-515-2441
Mailing Address - Fax:763-515-2442
Practice Address - Street 1:4749 CHICAGO AVE STE 2D
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4181
Practice Address - Country:US
Practice Address - Phone:503-267-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical