Healthcare Provider Details

I. General information

NPI: 1013950203
Provider Name (Legal Business Name): WILLIAM J AFFELDT MSSW LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 HART BLVD STE 100
MONTICELLO MN
55362-8929
US

IV. Provider business mailing address

1700 HIGHWAY 25 N
BUFFALO MN
55313-1930
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-2921
  • Fax: 763-581-9090
Mailing address:
  • Phone: 763-684-3719
  • Fax: 637-581-9090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4248
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4248
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: