Provider Demographics
NPI:1265809479
Name:BADE, EMILY ELIZABETH
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:BADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 LEXINGTON AVE. N
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-486-3808
Mailing Address - Fax:651-486-3858
Practice Address - Street 1:3490 LEXINGTON AVE. N
Practice Address - Street 2:SUITE 205
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:651-486-3808
Practice Address - Fax:651-486-3858
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN355385800Medicaid
MN355385800Medicaid