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General NPI Number Information
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NPI Number | 1760602536
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Entity Type | Individual
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Provider Name | ABIGAIL AILEEN BROOKS LICSW
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 251 WOOD LAKE SE ROCHESTER COMMUNITY BEHAVIORAL HEALTH HOSPITAL
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City | ROCHESTER
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State | MN
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Zip | 55904
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Country | US
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Telephone | 952-206-2573
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Fax |
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Provider Business Mailing Address
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Address Line | 17057 EAGLEVIEW WAY
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City | FARMINGTON
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State | MN
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Zip | 55024-7304
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Country | US
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Telephone | 612-913-6590
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Fax | 507-206-2573
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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 | 10607
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License Number State | MN
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