Healthcare Provider Details

I. General information

NPI: 1003725284
Provider Name (Legal Business Name): ANNA HAMER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6080 E RIVER RD
FRIDLEY MN
55432-5373
US

IV. Provider business mailing address

6000 MOORE LAKE DR W
FRIDLEY MN
55432-5601
US

V. Phone/Fax

Practice location:
  • Phone: 763-502-5314
  • Fax:
Mailing address:
  • Phone: 763-502-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1001811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: