Provider Demographics
NPI:1881556439
Name:FIEGENBAUM, EMBER LYNN
Entity type:Individual
Prefix:
First Name:EMBER
Middle Name:LYNN
Last Name:FIEGENBAUM
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 1:4846 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5702
Mailing Address - Country:US
Mailing Address - Phone:651-802-2533
Mailing Address - Fax:
Practice Address - Street 1:4846 PARK GLEN RD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5702
Practice Address - Country:US
Practice Address - Phone:651-802-2533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-02
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician