Healthcare Provider Details

I. General information

NPI: 1609674324
Provider Name (Legal Business Name): EMILY ADELE MOEWS MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 CLEVELAND AVE S STE 211
SAINT PAUL MN
55116-3845
US

IV. Provider business mailing address

790 CLEVELAND AVE S STE 211
SAINT PAUL MN
55116-3845
US

V. Phone/Fax

Practice location:
  • Phone: 612-428-2409
  • Fax:
Mailing address:
  • Phone: 612-428-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number493451
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25221
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: