Healthcare Provider Details

I. General information

NPI: 1679273452
Provider Name (Legal Business Name): EMILY KOENIG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MOUNTAIN ST E
CAVALIER ND
58220-4015
US

IV. Provider business mailing address

PO BOX 380
CAVALIER ND
58220-0380
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-6307
  • Fax: 701-265-6373
Mailing address:
  • Phone: 701-265-6307
  • Fax: 701-265-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5405
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5405
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: