Provider Demographics
NPI:1538920061
Name:GELDERT, EMILY (LICSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GELDERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:RUTTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:23 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7629
Mailing Address - Country:US
Mailing Address - Phone:952-529-0976
Mailing Address - Fax:
Practice Address - Street 1:23 9TH AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7629
Practice Address - Country:US
Practice Address - Phone:952-529-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN285361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical