| Edify Youth | |
|
5108 Lakeside Ave N Crystal MN 55429-3734 | |
| (612) 306-4575 | |
| (763) 271-2707 |
| Full Name | Edify Youth |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5108 Lakeside Ave N, Crystal, Minnesota |
| Authorized Official Name and Position | Michele Bauer (ADMINISTRATOR) |
| Authorized Official Contact | 7635673136 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edify Youth 5108 Lakeside Ave N Crystal MN 55429-3734 Ph: (612) 306-4575 | Edify Youth 5108 Lakeside Ave N Crystal MN 55429-3734 Ph: (612) 306-4575 |
| NPI Number | 1477895985 |
|---|---|
| Provider Enumeration Date | 03/22/2013 |
| Last Update Date | 03/22/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477895985 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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