Healthcare Provider Details

I. General information

NPI: 1336094309
Provider Name (Legal Business Name): EMBER & SHORE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12760 ABERDEEN ST NE STE 102
BLAINE MN
55449-5845
US

IV. Provider business mailing address

5123 COUNTY ROAD 6 NW
DALBO MN
55017-8305
US

V. Phone/Fax

Practice location:
  • Phone: 612-232-1202
  • Fax:
Mailing address:
  • Phone: 612-232-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEA ROSE SEMLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 612-232-1202