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General NPI Number Information
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NPI Number | 1063051639
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Entity Type | Individual
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Provider Name | DAWN EBELING
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Gender | Female
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 2970 JUDICIAL RD STE 100
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City | BURNSVILLE
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State | MN
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Zip | 55337-7822
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Country | US
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Telephone | 952-224-8990
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Fax |
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Provider Business Mailing Address
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Address Line | 5670 FAIRLAWN SHORES TRL SE
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City | PRIOR LAKE
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State | MN
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Zip | 55372-1968
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Country | US
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Telephone | 612-518-3687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15358
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License Number State | MN
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