=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629677554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBBIE RAE SEMMELROTH DNP, MSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2020
-----------------------------------------------------
Last Update Date | 02/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 E 9TH ST # 111
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-270-4779
-----------------------------------------------------
Fax | 218-216-8983
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 E 9TH ST # 111
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55805-1604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-270-4449
-----------------------------------------------------
Fax | 218-216-8983
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 27727
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------