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General NPI Number Information
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NPI Number | 1336545201
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Entity Type | Individual
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Provider Name | EVELYN KEBAYA
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Gender | Female
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 525 PORTLAND AVE MC 963
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City | MINNEAPOLIS
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State | MN
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Zip | 55415-1533
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Country | US
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Telephone | 612-387-7515
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 FLAG AVE N # 219
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City | NEW HOPE
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State | MN
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Zip | 55427-2400
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Country | US
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Telephone | 651-308-0820
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21045
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License Number State | MN
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