Healthcare Provider Details

I. General information

NPI: 1013834852
Provider Name (Legal Business Name): ANNA ROTH BLUMFIELD LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 GRAND AVE # 212
SAINT PAUL MN
55105-3002
US

IV. Provider business mailing address

1041 GRAND AVE # 212
SAINT PAUL MN
55105-3002
US

V. Phone/Fax

Practice location:
  • Phone: 651-300-4185
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4507
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: