Provider Demographics
NPI:1568219574
Name:MONSEN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MONSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 BLUE GENTIAN RD STE 125
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1554
Mailing Address - Country:US
Mailing Address - Phone:952-454-8751
Mailing Address - Fax:
Practice Address - Street 1:860 BLUE GENTIAN RD STE 125
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-1554
Practice Address - Country:US
Practice Address - Phone:952-454-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach