Healthcare Provider Details

I. General information

NPI: 1407763691
Provider Name (Legal Business Name): ECHO ANNE ALTHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12918 63RD AVE N
MAPLE GROVE MN
55369-6001
US

IV. Provider business mailing address

112 RUSTLE RD
JORDAN MN
55352-1609
US

V. Phone/Fax

Practice location:
  • Phone: 763-210-9966
  • Fax:
Mailing address:
  • Phone: 320-267-3695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4799
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: