Healthcare Provider Details

I. General information

NPI: 1730885492
Provider Name (Legal Business Name): ALBERT ABOUDEM ATEMKENG LGSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 HARKNESS AVE S
COTTAGE GROVE MN
55016-3869
US

IV. Provider business mailing address

520 DARIAN DR
PROSPER TX
75078-9403
US

V. Phone/Fax

Practice location:
  • Phone: 651-442-5157
  • Fax: 888-237-4035
Mailing address:
  • Phone: 651-442-5157
  • Fax: 888-237-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24497
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: