Healthcare Provider Details

I. General information

NPI: 1871186379
Provider Name (Legal Business Name): ANTHONY W KROSSCHELL LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 WAYZATA BLVD STE 100
MINNETONKA MN
55305-1500
US

IV. Provider business mailing address

10201 WAYZATA BLVD STE 100
MINNETONKA MN
55305-1500
US

V. Phone/Fax

Practice location:
  • Phone: 952-544-6806
  • Fax: 952-545-0098
Mailing address:
  • Phone: 952-544-6806
  • Fax: 952-545-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304054
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC02932
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: