Healthcare Provider Details

I. General information

NPI: 1104759703
Provider Name (Legal Business Name): ELIZABETH RUDEGEAIR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZA RUDEGEAIR LICSW

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S STE 460
EDINA MN
55435-1811
US

IV. Provider business mailing address

6600 FRANCE AVE S STE 460
EDINA MN
55435-1811
US

V. Phone/Fax

Practice location:
  • Phone: 651-395-5788
  • Fax: 651-454-3492
Mailing address:
  • Phone: 612-470-4122
  • Fax: 651-454-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number32578
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: