Healthcare Provider Details

I. General information

NPI: 1548826852
Provider Name (Legal Business Name): ANGELA MARIE BUELL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 COMMERCE DRIVE
WOODBURY MN
55125
US

IV. Provider business mailing address

721 COMMERCE DRIVE
WOODBURY MN
55125
US

V. Phone/Fax

Practice location:
  • Phone: 612-767-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26097
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: