Provider Demographics
NPI:1518038884
Name:DREWITZ, ELIZABETH K (PSYD, LP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:DREWITZ
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:MOSENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD LP
Mailing Address - Street 1:100 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6337
Mailing Address - Country:US
Mailing Address - Phone:507-334-3921
Mailing Address - Fax:
Practice Address - Street 1:100 STATE AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-6337
Practice Address - Country:US
Practice Address - Phone:507-334-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5863103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical