Healthcare Provider Details

I. General information

NPI: 1467398404
Provider Name (Legal Business Name): ANAH TERESE COLLEEN FITZGERALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 PARK AVE S # 200
SAINT CLOUD MN
56301-3713
US

IV. Provider business mailing address

5533 GARDEN HILLS DR
SAINT CLOUD MN
56301-4621
US

V. Phone/Fax

Practice location:
  • Phone: 320-301-0039
  • Fax:
Mailing address:
  • Phone: 320-301-0039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: