Edify Youth

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

EDIFY YOUTH

Practice address

5108 Lakeside Ave N
Crystal, MN 55429-3734

Phone

(612) 306-4575

Fax

(763) 271-2707

NPI assigned

Mar 22, 2013

Last updated

Mar 22, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michele Bauer

Title

Administrator

Phone

(763) 567-3136

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Chloe Britzius, LICSW

  • Mental Health Counselor
  • Osseo, MN
  • NPI 1669986378
  NPD (past)
• Shelly Denae Graf, LICSW

  • Clinical Social Worker
  • Maple Grove, MN
  • NPI 1306197751
  NPD (past)
• Seth Elliot Tupper, LICSW

  • Clinical Social Worker
  • Crystal, MN
  • NPI 1306271713
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363910400000",
    "number": "1477895985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 LAKESIDE AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293734",
            "telephone_number": "612-306-4575",
            "fax_number": "763-271-2707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5108 LAKESIDE AVE N",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554293734",
            "telephone_number": "612-306-4575",
            "fax_number": "763-271-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDIFY YOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-22",
        "last_updated": "2013-03-22",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "763-567-3136"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deborah S Dittberner, M.D.
• Twila Donley
• Sanbate Dufo
• Clint M Dworshak, PHARM.D.
• Marian Eckhardt, PSYD, LP
• Lauren E Ehlert, RDN, LD
• Nash William Kudjo Ekor
• Elite Home Healthcare
• Elite School Transportation
• Eloes Heritage LLC

• Clinical Social Worker in Crystal, MN
• Providers in Crystal, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.