Individual
AUTUMN MICHELLE PHENOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
6341 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4946
(612) 672-6999
Mailing address
2785 WHITE BEAR AVE N STE 403, MAPLEWOOD, MN 55109-1327
(651) 395-5775
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22651
MN
Other
Enumeration date
06/13/2019
Last updated
08/22/2019
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