Organization
EDIFY YOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE BAUER (ADMINISTRATOR)
(763) 567-3136
Entity
Organization
Contact information
Practice address
5108 LAKESIDE AVE N, CRYSTAL, MN 55429-3734
(612) 306-4575
(763) 271-2707
Mailing address
5108 LAKESIDE AVE N, CRYSTAL, MN 55429-3734
(612) 306-4575
(763) 271-2707
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/22/2013
Last updated
03/22/2013
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