Provider Demographics
NPI:1851101752
Name:NEU, ELIZABETH WALLACE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WALLACE
Last Name:NEU
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 1:9065 JUNEAU DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3514
Mailing Address - Country:US
Mailing Address - Phone:952-484-8108
Mailing Address - Fax:
Practice Address - Street 1:3503 HIGH POINT DR N, BUILDING 3, SUITE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55128
Practice Address - Country:US
Practice Address - Phone:952-479-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04784101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health