Healthcare Provider Details

I. General information

NPI: 1891604252
Provider Name (Legal Business Name): EMMA GRACE DOELL LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 BELLE AVE
MANKATO MN
56001-5250
US

IV. Provider business mailing address

2441 NORTHRIDGE DR
NORTH MANKATO MN
56003-1612
US

V. Phone/Fax

Practice location:
  • Phone: 507-735-6449
  • Fax: 507-888-0001
Mailing address:
  • Phone: 507-225-2206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number32215
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: