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NPI Code Detail

MEDICARE: LILYANNA ANDERSON LICSW

MEDICARE: LILYANNA ANDERSON LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker23525MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
123525OTHERMNLICSW

General Provider Information

NPI Number : 1760919419
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILYANNA ANDERSON LICSW
Provider Business Mailing Address
First Line : 3000 AMES CROSSING RD STE 600
Second Line :
City : EAGAN
State : MN
Zip : 55121-2570
Country : US
Telephone Number : 651-774-0011
Fax Number : 651-774-0606
Provider Business Practice Location Address
First Line : 2120 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-3378
Country : US
Telephone Number : 651-774-0011
Fax Number : 651-774-0606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2017
Last Update Date : 03/04/2026

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Directions to “ LILYANNA ANDERSON LICSW” Practice Location

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