Provider Demographics
NPI:1053947077
Name:TABER, NATALIE JEAN (MSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEAN
Last Name:TABER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 METRO BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3062
Mailing Address - Country:US
Mailing Address - Phone:612-268-5858
Mailing Address - Fax:
Practice Address - Street 1:6636 CEDAR AVE S STE 360
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2712
Practice Address - Country:US
Practice Address - Phone:612-268-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health