Healthcare Provider Details

I. General information

NPI: 1649069626
Provider Name (Legal Business Name): EMILY VAN KAMPEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13045 FALCON DR STE 100
BAXTER MN
56425-4201
US

IV. Provider business mailing address

26214 COUNTY ROAD 4
NISSWA MN
56468-2184
US

V. Phone/Fax

Practice location:
  • Phone: 218-829-9307
  • Fax: 218-829-7649
Mailing address:
  • Phone: 612-670-2265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: