Healthcare Provider Details

I. General information

NPI: 1346780939
Provider Name (Legal Business Name): MAGAN ANNE CALLAWAY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAGAN ANNE OLSON DENNIS

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 06/22/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 METRO BLVD STE 250
EDINA MN
55439-3062
US

IV. Provider business mailing address

2586 7TH AVE E SUITE 302
NORTH ST PAUL MN
55109-3083
US

V. Phone/Fax

Practice location:
  • Phone: 612-447-0947
  • Fax:
Mailing address:
  • Phone: 651-633-7300
  • Fax: 651-633-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22605
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: