Healthcare Provider Details

I. General information

NPI: 1679419071
Provider Name (Legal Business Name): REBECCA DONALDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 EQUITABLE DR STE 205
EDEN PRAIRIE MN
55344-3689
US

IV. Provider business mailing address

18131 GLASSFERN LN
LAKEVILLE MN
55044-2233
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-0878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31589
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: