Provider Demographics
NPI:1093011827
Name:CONRAD, ANN MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:FASNACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:8640 EAGLE CREEK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-746-7664
Mailing Address - Fax:952-746-0582
Practice Address - Street 1:8640 EAGLE CREEK CIRCLE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-746-7664
Practice Address - Fax:952-746-0582
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health