Provider Demographics
NPI:1336338284
Name:DEBAUN, KAREN RAE (LICSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:RAE
Last Name:DEBAUN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17305 CEDAR AVE S
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3901
Mailing Address - Country:US
Mailing Address - Phone:952-435-4144
Mailing Address - Fax:952-435-4149
Practice Address - Street 1:17305 CEDAR AVE S
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-3901
Practice Address - Country:US
Practice Address - Phone:952-435-4144
Practice Address - Fax:952-435-4149
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical