Healthcare Provider Details

I. General information

NPI: 1598353484
Provider Name (Legal Business Name): ANNA WELLE MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 2ND ST S STE 135
SAINT CLOUD MN
56301-3705
US

IV. Provider business mailing address

2848 2ND ST S STE 135
SAINT CLOUD MN
56301-3705
US

V. Phone/Fax

Practice location:
  • Phone: 763-428-2288
  • Fax:
Mailing address:
  • Phone: 763-428-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26634
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: