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General NPI Number Information
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NPI Number | 1255508537
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Entity Type | Organization
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Legal Business Name | ABC CHILD & FAMILY THERAPY CENTER
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 40 16TH ST SE SUITE D
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City | ROCHESTER
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State | MN
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Zip | 55904-7987
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Country | US
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Telephone | 507-536-7662
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Fax | 507-536-7664
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Provider Business Mailing Address
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Address Line | PO BOX 894
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City | ROCHESTER
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State | MN
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Zip | 55903-0894
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Country | US
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Telephone | 507-536-7662
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Fax | 507-536-7664
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Authorized Official
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Title or Position | DIRECTOR/THERAPIST
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Name | JUDY M DAWLEY
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Credential | MSW, LICSW, RPT-S
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Telephone | 507-536-7662
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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 | 8385
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License Number State | MN
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