1043378573 NPI number — STEPHANIE KEEFFE ROSSING L.M.F.T.

Table of content: STEPHANIE KEEFFE ROSSING L.M.F.T. (NPI 1043378573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043378573 NPI number — STEPHANIE KEEFFE ROSSING L.M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSSING
Provider First Name:
STEPHANIE
Provider Middle Name:
KEEFFE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043378573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5209 HAMILTON LN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55443-2345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-286-4257
Provider Business Mailing Address Fax Number:
763-432-7424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12760 ABERDEEN ST NE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BLAINE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55449-5845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-286-4257
Provider Business Practice Location Address Fax Number:
763-432-7424
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1185 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1043378573 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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