Groteboer-Distad, Emily Ann
Groteboer-Distad, Emily Ann is an individual health care provider with primary practice located at 15265 Carrousel Way Ste 100 , Rosemount MN 55068-1760. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Groteboer-Distad, Emily Ann can be contacted via phone (952) 443-4600.Contact Information
Primary practice address
15265 Carrousel Way Ste 100
Rosemount MN 55068-1760
Phone: (952) 443-4600
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | ||
| Behavioral Health & Social Service Providers / Mental Health | 101YM0800X | CC02555 | Minnesota |
Profile Details
| NPI number | 1942855408 |
|---|---|
| LBN Legal business name | Groteboer-Distad, Emily Ann |
| Credentials | MS, LPCC, NCC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 1st, 2019 |
| Last updated | Jan 7th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1942855408 | NPPES |
| Other | NA | NA |
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