Provider Demographics
NPI:1801537865
Name:ENGRAV, ABBIGAIL A
Entity type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:A
Last Name:ENGRAV
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 1:2520 PILOT KNOB RD
Mailing Address - Street 2:STE 190
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120
Mailing Address - Country:US
Mailing Address - Phone:651-452-1500
Mailing Address - Fax:651-452-1502
Practice Address - Street 1:2605 FERRNBROOK LANE N
Practice Address - Street 2:STE E
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447
Practice Address - Country:US
Practice Address - Phone:763-276-9135
Practice Address - Fax:763-496-1431
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health