Provider Demographics
NPI:1073716759
Name:MCRAD, REBEKA ELLEN (LICSW)
Entity type:Individual
Prefix:
First Name:REBEKA
Middle Name:ELLEN
Last Name:MCRAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9342 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-3928
Mailing Address - Country:US
Mailing Address - Phone:952-600-5409
Mailing Address - Fax:888-865-2117
Practice Address - Street 1:5666 LINCOLN DR STE 210
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-1672
Practice Address - Country:US
Practice Address - Phone:612-367-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN294441041C0700X
OK40901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical