Healthcare Provider Details

I. General information

NPI: 1376000596
Provider Name (Legal Business Name): EMMA CHRISTINE EVANS-PECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2019
Last Update Date: 03/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 4TH ST. NW SUITE B
AUSTIN MN
55912
US

IV. Provider business mailing address

205 4TH ST. NW SUITE B
AUSTIN MN
55912
US

V. Phone/Fax

Practice location:
  • Phone: 507-396-6720
  • Fax:
Mailing address:
  • Phone: 507-396-6720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number14863
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: