Healthcare Provider Details

I. General information

NPI: 1033847314
Provider Name (Legal Business Name): EMMA KIM RUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMMA RUST

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 GRAND AVE
SAINT PAUL MN
55105-2885
US

IV. Provider business mailing address

2138 MARSHALL AVE
SAINT PAUL MN
55104-5756
US

V. Phone/Fax

Practice location:
  • Phone: 612-424-2466
  • Fax: 612-677-3146
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.028222
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number31498
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: