Provider Demographics
NPI:1336827070
Name:DREVLOW, EMILY JANE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:DREVLOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4825 58TH AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2821
Mailing Address - Country:US
Mailing Address - Phone:701-213-0726
Mailing Address - Fax:612-446-5798
Practice Address - Street 1:4825 58TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55429-2821
Practice Address - Country:US
Practice Address - Phone:701-213-0726
Practice Address - Fax:612-446-5798
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician