Provider Demographics
NPI:1134687817
Name:MISKOVICH, ANN ELIZABETH JOAN (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:ELIZABETH JOAN
Last Name:MISKOVICH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:725 CLEVELAND AVE S APT 216
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3327
Mailing Address - Country:US
Mailing Address - Phone:218-259-0676
Mailing Address - Fax:
Practice Address - Street 1:3300 COUNTY ROAD 10 STE 500
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3068
Practice Address - Country:US
Practice Address - Phone:763-560-8331
Practice Address - Fax:763-560-8431
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02051101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health