Healthcare Provider Details

I. General information

NPI: 1851015192
Provider Name (Legal Business Name): ANNA CHRISTINE BAILEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E LAKE ST FL 5
MINNEAPOLIS MN
55407-4385
US

IV. Provider business mailing address

7624 MORGAN AVE N
BROOKLYN PARK MN
55444-2428
US

V. Phone/Fax

Practice location:
  • Phone: 612-596-9438
  • Fax:
Mailing address:
  • Phone: 763-607-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number20484
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20484
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: