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General NPI Number Information
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NPI Number | 1447025713
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Entity Type | Individual
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Provider Name | DEVIN RAE HENDRICKSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/16/2023
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 1205 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-2634
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Country | US
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Telephone | 612-520-9090
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Fax |
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Provider Business Mailing Address
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Address Line | 1094 SAINT CLAIR AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3266
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Country | US
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Telephone | 952-686-3652
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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 | 29861
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License Number State | MN
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