MEDICARE: EMILY ABELN M.A., L.P.

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	103TC1900X	Counseling Psychologist	LP5247	MN

General Provider Information

NPI Number	:	1417256587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ABELN M.A., L.P.

Provider Business Mailing Address
First Line	:	5705 COLFAX AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55419-1705
Country	:	US
Telephone Number	:	612-382-4715
Fax Number	:	612-445-0112

Provider Business Practice Location Address
First Line	:	1919 NICOLLET AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55403-3747
Country	:	US
Telephone Number	:	612-445-0225
Fax Number	:	612-445-0112

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	05/13/2022

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