| Donna Anderson Licsw, Pa | |
|
1711 County Road B W Suite 210s Roseville MN 55113-4057 | |
| (651) 621-2495 | |
| (651) 621-2496 |
| Full Name | Donna Anderson Licsw, Pa |
|---|---|
| Speciality | Social Worker |
| Location | 1711 County Road B W, Roseville, Minnesota |
| Authorized Official Name and Position | Donna Anderson (PSYCHOTHERAPIST) |
| Authorized Official Contact | 6516212495 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Donna Anderson Licsw, Pa 1711 County Road B W Suite 210s Roseville MN 55113-4057 Ph: (651) 621-2495 | Donna Anderson Licsw, Pa 1711 County Road B W Suite 210s Roseville MN 55113-4057 Ph: (651) 621-2495 |
| NPI Number | 1720351158 |
|---|---|
| Provider Enumeration Date | 02/15/2012 |
| Last Update Date | 02/15/2012 |
| Medicare PECOS PAC ID | 9335392018 |
|---|---|
| Medicare Enrollment ID | O20130107000030 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720351158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | LICSW 1288 (Minnesota) | Primary |
| Provider Name | Donna G Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669491908 PECOS PAC ID: 9234328790 Enrollment ID: I20110113001183 |
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