Provider Demographics
NPI:1154059368
Name:VANDENBERG-DAVES, ALLISON RAE (LGSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:RAE
Last Name:VANDENBERG-DAVES
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3548 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4119
Mailing Address - Country:US
Mailing Address - Phone:608-397-7368
Mailing Address - Fax:
Practice Address - Street 1:3548 BRYANT AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4119
Practice Address - Country:US
Practice Address - Phone:612-822-8227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN312701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical