Provider Demographics
NPI:1558315846
Name:BENSON, EMILY (MSW, LICSW, SEP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:MSW, LICSW, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5666 LINCOLN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1673
Mailing Address - Country:US
Mailing Address - Phone:612-367-6029
Mailing Address - Fax:612-326-9828
Practice Address - Street 1:5666 LINCOLN DR STE 101
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1673
Practice Address - Country:US
Practice Address - Phone:612-367-6029
Practice Address - Fax:612-326-9828
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17531104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker