ELISE BRODERICK QUAM (NPI# 1891269155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891269155 |
| Entity Type | Individual |
| Full Name | ELISE BRODERICK QUAM |
| Credential | MSW, LICSW |
| Practice Address |
3450 Oleary Ln Eagan MN 55123 |
| Mailing Address |
3450 Oleary Ln Eagan MN 55123-2340 |
| Practice Telephone | 6514540114 |
| Mailing Telephone | 6513658628 |
| Enumeration Date | 2019-01-18 |
| Last Update Date | 2019-01-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1041C0700X |
Social Worker Specialization: Clinical |
25498 | MN | Behavioral Health & Social Service Providers |
| Street Address |
3450 OLEARY LN |
| City | EAGAN |
| State | MN |
| Zip Code | 55123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750366167 | Patrice Lauer-roberts | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2005-12-08 |
| 1083224232 | Saoirse Mcmahon | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-08-03 |
| 1194334318 | Lisa Joy Rutman | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-07-23 |
| 1265065114 | Kaibeh Benson | Nurse Practitioner | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2020-02-19 |
| 1952942476 | Emily J Holton | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-10-06 |
| 1730733098 | Joshua Hampton Goodwin | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-07-25 |
| 1992369664 | Mary Annette Freitag | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-04-27 |
| 1730742792 | Shannon Derfus | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-04-16 |
| 1669930012 | Brian Nelson | Counselor | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2019-03-05 |
| 1124599345 | Megan Mcteague | Social Worker | 3450 Oleary Ln, Eagan, MN 55123-2340 | 2018-12-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053828467 | Hilltop Family Chiropractic Center Pa | Chiropractor | 1121 Town Centre Drive Suite 202, Eagan, MN 55123 | 2018-01-08 |
| 1922452507 | Jacob Zimmerman | Counselor | 3450 O'leary Ln., Eagan, MN 55123 | 2016-04-20 |
| 1316320971 | K-squared Fitness, L.L.C. | Public Health or Welfare | 1100 Cliff Rd, Eagan, MN 55123 | 2015-07-01 |
| 1346683687 | Joshua M Dorn | Allergy & Immunology | 3460 Promenade Ave, Eagan, MN 55123 | 2013-04-16 |
| 1700172350 | Mary Christine Mcnabney | Nurse Practitioner | 610 Opperman Drive, D4 Health Center, Your Wellbeing Health Center, Eagan, MN 55123 | 2011-06-22 |
| 1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
| 1821025271 | Mngi Endoscopy LLC | Clinic/Center | 1185 Town Centre Drive, Eagan, MN 55123 | 2006-06-28 |
| 1780620120 | Cindy Eileen Wood | Audiologist | 3440 Oleary Lane, 240, Eagan, MN 55123 | 2006-06-22 |
| 1609845742 | Jeffery R Dichter | Internal Medicine | 849 Govern Circle, Saint Paul, MN 55123 | 2006-03-14 |
| 1962932491 | Maliah J Mcgraw | Dentist | 1121 Town Centre Dr Ste 200, Eagan, MN 55123 | 2017-06-18 |
| Find all providers in zip 55123 | ||||
| Taxonomy Code | 1041C0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Social Worker |
| Specialization | Clinical |
| A social worker who holds a master’s or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master’s supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances. |
| Notes: Source: National Association of Social Workers, 2008 [7/1/2009: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508264268 | Jane Martins | Social Worker | 1765 Forssa Way, Eagan, MN 55122-2693 | 2014-12-11 |
| 1033353669 | Todd Borstad | Social Worker | 3450 O'leary Lane, Eagan, MN 55123 | 2009-04-27 |
| 1497966238 | Jessica Ann Peterson | Social Worker | 1585 Thomas Center Dr, Ste 104, Eagan, MN 55122-3039 | 2007-05-24 |
| 1780805218 | Bridget Marie Mcconnell | Social Worker | 680 O'neill Drive, Eagan, MN 55121 | 2007-05-01 |
| 1619197167 | James P Hobday Acsw Licsw | Social Worker | 4030 Pilot Knob Rd, Eagan, MN 55122-1814 | 2007-04-26 |
| 1114049772 | Beth Ann Nelson | Social Worker | 4660 Slater Road, Suite 210, Eagan, MN 55122-4055 | 2007-04-04 |
| 1194866764 | Gayle Marian Williams | Social Worker | 4475 Fawn Ridge Trl, Eagan, MN 55123-2090 | 2007-02-08 |
| 1427124205 | Susan Jean Murr | Social Worker | 4655 Nicols Rd Ste 206, Eagan, MN 55122-2395 | 2006-11-25 |
| 1063518025 | Donna Jean Snetting | Social Worker | 3460 Washington Drive, Suite 200, Eagan, MN 55122-1338 | 2006-09-16 |
| 1215041694 | Robert John Dejdar | Social Worker | 1415 Cutters Ln, Eagan, MN 55122-3800 | 2006-08-19 |
| Find all providers in EAGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.