Healthcare Provider Details

I. General information

NPI: 1487774063
Provider Name (Legal Business Name): REBECCA LYNNE MALAN MSW, LICSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNNE RASCHE

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 THOMPSON AVE E STE 150
WEST ST PAUL MN
55118-3238
US

IV. Provider business mailing address

4240 PARK GLEN RD
ST LOUIS PARK MN
55416-5427
US

V. Phone/Fax

Practice location:
  • Phone: 651-450-0860
  • Fax: 651-450-0759
Mailing address:
  • Phone: 612-925-6033
  • Fax: 612-925-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number06003
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number43556
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number36156
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-8911283
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: