Provider Demographics
NPI:1851929780
Name:ENNO, NATALIE ROSE AVEY (MHP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:ROSE AVEY
Last Name:ENNO
Suffix:
Gender:F
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 WASHINGTON DR STE 110
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4301
Mailing Address - Country:US
Mailing Address - Phone:651-412-8893
Mailing Address - Fax:
Practice Address - Street 1:3460 WASHINGTON DR STE 110
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4301
Practice Address - Country:US
Practice Address - Phone:651-412-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist