Healthcare Provider Details

I. General information

NPI: 1922903210
Provider Name (Legal Business Name): ALLISON BROCKWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 LONG LAKE RD STE 215
NEW BRIGHTON MN
55112-6428
US

IV. Provider business mailing address

1942 FISH TRAP LAKE DR
CUSHING MN
56443-2000
US

V. Phone/Fax

Practice location:
  • Phone: 612-900-0233
  • Fax: 866-627-0910
Mailing address:
  • Phone: 320-249-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: