Healthcare Provider Details

I. General information

NPI: 1811993421
Provider Name (Legal Business Name): CONSTANCE ANDERSON AAGARD MSED,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CONSTANCE JOAN ANDERSON MSED

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 8TH AVE. SE
BAUDETTE MN
56623
US

IV. Provider business mailing address

PO BOX 1523
BEMIDJI MN
56619-1523
US

V. Phone/Fax

Practice location:
  • Phone: 218-634-1499
  • Fax: 218-634-4520
Mailing address:
  • Phone: 218-634-1499
  • Fax: 218-634-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP 0390
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: