Provider Demographics
NPI:1861956948
Name:KOSKINIEMI, REBECCA (LICSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KOSKINIEMI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-0341
Mailing Address - Country:US
Mailing Address - Phone:218-731-8896
Mailing Address - Fax:855-852-5355
Practice Address - Street 1:118 MAIN AVE N STE 203
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-4405
Practice Address - Country:US
Practice Address - Phone:218-731-8896
Practice Address - Fax:855-852-5355
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN239991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical