Healthcare Provider Details

I. General information

NPI: 1285870030
Provider Name (Legal Business Name): ELIZABETH M ANEZ LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 MENDOTA HEIGHTS RD STE 200
MENDOTA HEIGHTS MN
55120
US

IV. Provider business mailing address

154 BRIDGEWATER TRL
HUDSON WI
54016-7778
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-9800
  • Fax: 651-405-0358
Mailing address:
  • Phone: 715-497-6678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18477
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: