=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831052646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ABBIE LUPELOW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2025
-----------------------------------------------------
Last Update Date | 12/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6640 SHADY OAK RD STE 401
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-7834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-256-7166
-----------------------------------------------------
Fax | 888-427-8048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 WILSON AVE RM 330
-----------------------------------------------------
City | MENOMONIE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54751-2746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-256-7166
-----------------------------------------------------
Fax | 888-427-8048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 306773
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------