Provider Demographics
NPI:1992687719
Name:VIRDEN, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:VIRDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 FORSHAM LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1987
Mailing Address - Country:US
Mailing Address - Phone:612-481-5659
Mailing Address - Fax:
Practice Address - Street 1:7250 HUDSON BLVD N STE 205
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7162
Practice Address - Country:US
Practice Address - Phone:651-867-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN322571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical