Provider Demographics
NPI:1033926324
Name:RABE, ANDREW S (LADC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:RABE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 HAZELWOOD ST APT 102
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1238
Mailing Address - Country:US
Mailing Address - Phone:612-250-5718
Mailing Address - Fax:
Practice Address - Street 1:3090 HAZELWOOD ST APT 102
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1238
Practice Address - Country:US
Practice Address - Phone:612-250-5718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306493101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)