Healthcare Provider Details

I. General information

NPI: 1669166955
Provider Name (Legal Business Name): OLIVIA GALE DOBBS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 XERXES AVE S STE 110
BLOOMINGTON MN
55431-1200
US

IV. Provider business mailing address

12400 PORTLAND AVE STE 130
BURNSVILLE MN
55337-6839
US

V. Phone/Fax

Practice location:
  • Phone: 612-718-4859
  • Fax: 612-662-8779
Mailing address:
  • Phone: 612-718-4859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31059
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: