Individual
EBONY GUMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1544 GREENWOOD CT N, EAGAN, MN 55122-1306
(612) 310-2873
Mailing address
1544 GREENWOOD CT N, EAGAN, MN 55122-1306
(612) 310-2873
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
22523
MN
1041C0700X
Clinical Social Worker
SWI.LW.61505637
WA
Other
Enumeration date
08/08/2020
Last updated
05/07/2026
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