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NPI Code Detail

MEDICARE: MS. EMILY THERESE STAPLES

MEDICARE: MS. EMILY THERESE STAPLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2390200000XStudent in an Organized Health Care Education/Training Program
31041C0700XClinical Social Worker27406MN

General Provider Information

NPI Number : 1336663566
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. EMILY THERESE STAPLES
Provider Business Mailing Address
First Line : 3205 ENSIGN AVE N
Second Line :
City : NEW HOPE
State : MN
Zip : 55427-1719
Country : US
Telephone Number : 651-328-7027
Fax Number :
Provider Business Practice Location Address
First Line : 4969 OLSON MEMORIAL HWY
Second Line :
City : GOLDEN VALLEY
State : MN
Zip : 55422-5138
Country : US
Telephone Number : 763-575-8086
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2017
Last Update Date : 05/15/2023

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Directions to “ MS. EMILY THERESE STAPLES ” Practice Location

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