Healthcare Provider Details

I. General information

NPI: 1528713153
Provider Name (Legal Business Name): ANNA MCCORMICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 94TH ST
BLOOMINGTON MN
55420-4206
US

IV. Provider business mailing address

2101 WOODDALE DR STE A
WOODBURY MN
55125-2933
US

V. Phone/Fax

Practice location:
  • Phone: 651-738-9888
  • Fax:
Mailing address:
  • Phone: 651-738-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: