Provider Demographics
NPI:1841548070
Name:FOELL, REBECCA ERIN (MSSW LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ERIN
Last Name:FOELL
Suffix:
Gender:F
Credentials:MSSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 FERNBROOK LN N
Mailing Address - Street 2:#120
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5338
Mailing Address - Country:US
Mailing Address - Phone:763-559-7050
Mailing Address - Fax:763-559-7060
Practice Address - Street 1:3300 FERNBROOK LN N
Practice Address - Street 2:#120
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5338
Practice Address - Country:US
Practice Address - Phone:763-559-7050
Practice Address - Fax:763-559-7060
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNAP12-10671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical