Healthcare Provider Details

I. General information

NPI: 1366909285
Provider Name (Legal Business Name): BRIANNA MARIE PEZON MSW, LICSW, MAOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

IV. Provider business mailing address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

V. Phone/Fax

Practice location:
  • Phone: 612-807-9324
  • Fax:
Mailing address:
  • Phone: 612-268-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: