Provider Demographics
NPI:1952587024
Name:REBEHN, SALLY ANN (LADC, ADCR-MN)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ANN
Last Name:REBEHN
Suffix:
Gender:F
Credentials:LADC, ADCR-MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 WESTBROOKE WAY
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8050
Mailing Address - Country:US
Mailing Address - Phone:612-998-5752
Mailing Address - Fax:
Practice Address - Street 1:2220 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3708
Practice Address - Country:US
Practice Address - Phone:612-789-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)