Healthcare Provider Details

I. General information

NPI: 1689381550
Provider Name (Legal Business Name): EKATERINA ANDREA ILIN-GRUPA LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EKATERINA ANDREA NEW LCSW, LICSW

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 FORD PKWY
SAINT PAUL MN
55116-3337
US

IV. Provider business mailing address

2270 FORD PKWY
SAINT PAUL MN
55116-3337
US

V. Phone/Fax

Practice location:
  • Phone: 763-647-5366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number69046
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30525
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: