Healthcare Provider Details

I. General information

NPI: 1245870088
Provider Name (Legal Business Name): MICHAEL ANNE KASZUBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 HIGHWAY 7
ST LOUIS PARK MN
55426-4223
US

IV. Provider business mailing address

391 LAUREL AVE APT 103
SAINT PAUL MN
55102-2075
US

V. Phone/Fax

Practice location:
  • Phone: 952-814-0207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC05353
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: