Provider Demographics
NPI:1659747780
Name:BRUNELLE, AMBER (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BRUNELLE
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-0704
Mailing Address - Country:US
Mailing Address - Phone:218-368-6233
Mailing Address - Fax:
Practice Address - Street 1:1113 E FRANKLIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2974
Practice Address - Country:US
Practice Address - Phone:612-721-0331
Practice Address - Fax:612-729-7834
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical