=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346780939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAGAN ANNE CALLAWAY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2017
-----------------------------------------------------
Last Update Date | 06/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7401 METRO BLVD STE 250
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-447-0947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2586 7TH AVE E SUITE 302
-----------------------------------------------------
City | NORTH ST PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55109-3083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-633-7300
-----------------------------------------------------
Fax | 651-633-7301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 22605
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------