MEDICARE: EMILY ANN KOOSER LPC

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
1	101YP2500X	Professional Counselor	1085-9-15-20	ND

General Provider Information

NPI Number	:	1336808682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANN KOOSER LPC

Provider Business Mailing Address
First Line	:	4575 32ND AVE S STE 3
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3305
Country	:	US
Telephone Number	:	701-353-7579
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 32ND AVE S STE 3
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-3305
Country	:	US
Telephone Number	:	701-353-7579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	05/15/2025

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Directions to “ EMILY ANN KOOSER LPC” Practice Location

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