Healthcare Provider Details

I. General information

NPI: 1750291720
Provider Name (Legal Business Name): MIKAYLA WITTER SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 125TH AVE NE
BLAINE MN
55434-3141
US

IV. Provider business mailing address

2727 N FERRY ST
ANOKA MN
55303-1650
US

V. Phone/Fax

Practice location:
  • Phone: 763-506-3000
  • Fax:
Mailing address:
  • Phone: 763-506-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number36576
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: