Healthcare Provider Details

I. General information

NPI: 1639250111
Provider Name (Legal Business Name): CENTER FOR HUMAN DEVELOPMENT OF WHITE BEAR LAKE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 WHITE BEAR PKWY SUITE 1800
WHITE BEAR LAKE MN
55110-3678
US

IV. Provider business mailing address

4505 WHITE BEAR PKWY SUITE 1800
WHITE BEAR LAKE MN
55110-3678
US

V. Phone/Fax

Practice location:
  • Phone: 651-426-8191
  • Fax: 651-426-6766
Mailing address:
  • Phone: 651-426-8191
  • Fax: 651-426-6766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: NANCY L SOETE
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 651-426-8191