Individual
BRENDA JEAN DEMOTTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
14985 GLAZIER AVE, SUITE 555, APPLE VALLEY, MN 55124-7484
(952) 891-2525
(952) 891-1800
Mailing address
13027 GARVIN BROOK LN, APPLE VALLEY, MN 55124-7245
(952) 432-2669
(952) 891-1800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
05559
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02S54DE
BLUECROSS AND BLUESHIELD
MN
01
—
62-41666
MEDICA
MN
01
—
990991046670
PREFERREDONE ADMINISTRATA
MN
01
—
V41193711663852
HELATHPARTNERS
MN
Enumeration date
11/01/2006
Last updated
07/08/2007
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