Provider Demographics
NPI:1679339964
Name:PELACH, EMMA (LMSW)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:PELACH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:HAFDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1424 W CENTURY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0917
Mailing Address - Country:US
Mailing Address - Phone:701-805-1939
Mailing Address - Fax:
Practice Address - Street 1:1424 W CENTURY AVE STE 103
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0917
Practice Address - Country:US
Practice Address - Phone:701-805-1939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND66771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical