Individual
DEBRA JEAN WAITE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
5100 GAMBLE DR, SUITE 100 MAIL STOP 31200A, SAINT LOUIS PARK, MN 55416-1521
(952) 593-8777
(952) 595-6408
Mailing address
8100 34TH AVE S, 21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7961
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2163
MN
Other
Enumeration date
02/27/2006
Last updated
07/08/2007
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