Healthcare Provider Details

I. General information

NPI: 1821735887
Provider Name (Legal Business Name): MS. ANNA LEE CRITTENDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 STILLWATER ST
SAINT PAUL MN
55110-5826
US

IV. Provider business mailing address

1736 STILLWATER ST
SAINT PAUL MN
55110-5826
US

V. Phone/Fax

Practice location:
  • Phone: 612-633-6064
  • Fax:
Mailing address:
  • Phone: 651-271-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: