Provider Demographics
NPI:1386791358
Name:FIEBIGER, MARY (MA,LP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FIEBIGER
Suffix:
Gender:F
Credentials:MA,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 DIVISION ST S STE 216
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2046
Mailing Address - Country:US
Mailing Address - Phone:507-664-9566
Mailing Address - Fax:
Practice Address - Street 1:220 DIVISION ST S STE 216
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2046
Practice Address - Country:US
Practice Address - Phone:507-664-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health