Individual
EMILY ANN GROTEBOER-DISTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LPCC, NCC
Contact information
Practice address
15265 CARROUSEL WAY STE 100, ROSEMOUNT, MN 55068-1760
(952) 443-4600
Mailing address
PO BOX 51, VICTORIA, MN 55386-0051
(952) 443-4600
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC02555
MN
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
08/01/2019
Last updated
01/07/2021
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