Healthcare Provider Details

I. General information

NPI: 1225942675
Provider Name (Legal Business Name): ABBY MUSEGADES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COUNTY ROAD B W
ROSEVILLE MN
55113-4526
US

IV. Provider business mailing address

701 COUNTY ROAD B W
ROSEVILLE MN
55113-4526
US

V. Phone/Fax

Practice location:
  • Phone: 651-487-4399
  • Fax: 651-487-4379
Mailing address:
  • Phone: 651-487-4399
  • Fax: 651-487-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number470574
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: