Provider Demographics
NPI:1205061785
Name:WHITE, REBECCA SARAH (MA, LP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SARAH
Last Name:WHITE
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 1:5256 ABBOTT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2125
Mailing Address - Country:US
Mailing Address - Phone:612-922-7052
Mailing Address - Fax:
Practice Address - Street 1:180 5TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2672
Practice Address - Country:US
Practice Address - Phone:651-265-1337
Practice Address - Fax:651-265-1400
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3861103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist