| Dawn Draayer-thibodeau, Llc | |
|
4500 Park Glen Rd Suite 155 St Louis Park MN 55416-4871 | |
| (952) 334-1213 | |
| (952) 928-9774 |
| Full Name | Dawn Draayer-thibodeau, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4500 Park Glen Rd, St Louis Park, Minnesota |
| Authorized Official Name and Position | Dawn Diana Draayer-thibodeau (THERAPIST) |
| Authorized Official Contact | 9523341213 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dawn Draayer-thibodeau, Llc 4500 Park Glen Rd Suite 155 St Louis Park MN 55416-4871 Ph: (952) 334-1213 | Dawn Draayer-thibodeau, Llc 4500 Park Glen Rd Suite 155 St Louis Park MN 55416-4871 Ph: (952) 334-1213 |
| NPI Number | 1235524521 |
|---|---|
| Provider Enumeration Date | 04/02/2015 |
| Last Update Date | 04/02/2015 |
| Medicare PECOS PAC ID | 4082934310 |
|---|---|
| Medicare Enrollment ID | O20150527002302 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235524521 | NPI | - | NPPES |
| 78612312-00 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 15185 (Minnesota) | Primary |
| Provider Name | Dawn D Draayer-thibodeau |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972672087 PECOS PAC ID: 5799722849 Enrollment ID: I20050411001078 |
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