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General NPI Number Information
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NPI Number | 1164317392
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Entity Type | Individual
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Provider Name | ABBEGAIL NICHOLE DUFAULT
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Gender | Female
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 9382 OAK AVE
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City | WACONIA
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State | MN
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Zip | 55387-9422
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Country | US
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Telephone | 855-454-2463
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Fax | 320-295-7898
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Provider Business Mailing Address
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Address Line | 2915 CLOVER RIDGE DR APT 413
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City | CHASKA
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State | MN
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Zip | 55318-4627
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Country | US
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Telephone | 507-461-0531
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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