Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 18777 | MN |
NPI | 1003124942 |
---|---|
Provider Name | Donn C Beaubien |
First Address | Brainerd, MN 56401-2902 |
Second Address | Brainerd, MN 56401-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2010 |
Last Update Date | 14/09/2010 |