Provider Demographics
NPI:1437623477
Name:REMPELEWERT, ANGELA (MA LPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:REMPELEWERT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19372 FRANCONIA TRL
Mailing Address - Street 2:
Mailing Address - City:SHAFER
Mailing Address - State:MN
Mailing Address - Zip Code:55074-2116
Mailing Address - Country:US
Mailing Address - Phone:309-369-9329
Mailing Address - Fax:
Practice Address - Street 1:15251 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:CENTER CITY
Practice Address - State:MN
Practice Address - Zip Code:55012-9640
Practice Address - Country:US
Practice Address - Phone:651-213-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3383-125101YP2500X
MN02018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40950000Medicaid