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General NPI Number Information
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NPI Number | 1376534214
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Entity Type | Individual
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Provider Name | DOUGLAS ALAN DREW MA, LICSW
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10190 BALTIMORE ST NE SUITE 110
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City | BLAINE
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State | MN
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Zip | 55449-5056
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Country | US
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Telephone | 763-755-7612
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Fax | 763-775-2048
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Provider Business Mailing Address
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Address Line | 14701 HARPERS ST NE
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City | HAM LAKE
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State | MN
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Zip | 55304-6428
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Country | US
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Telephone | 763-413-2829
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Fax | 763-413-5225
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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 | 7998
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License Number State | MN
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