Healthcare Provider Details

I. General information

NPI: 1285304360
Provider Name (Legal Business Name): ANNE CRISPO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 MILLER TRUNK HWY STE 209
DULUTH MN
55811-4448
US

IV. Provider business mailing address

7975 SHIPLEY RD
CULVER MN
55779-8049
US

V. Phone/Fax

Practice location:
  • Phone: 218-524-8889
  • Fax:
Mailing address:
  • Phone: 218-393-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCC02952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: