Healthcare Provider Details

I. General information

NPI: 1225848906
Provider Name (Legal Business Name): BRENDEN ORMSBY MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W STE 6
SAINT PAUL MN
55104-3435
US

IV. Provider business mailing address

1919 UNIVERSITY AVE W STE 6
SAINT PAUL MN
55104-3435
US

V. Phone/Fax

Practice location:
  • Phone: 651-641-1555
  • Fax: 651-641-0340
Mailing address:
  • Phone: 651-641-1555
  • Fax: 651-641-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number29519
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: