Healthcare Provider Details

I. General information

NPI: 1619433950
Provider Name (Legal Business Name): CHRISTINE ELIZABETH ANDERSON MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 WEIR DR STE 270
WOODBURY MN
55125-6741
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 651-714-9646
  • Fax:
Mailing address:
  • Phone: 651-529-8315
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21628
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: