Provider Demographics
NPI:1164879326
Name:HELGESON, ANYA
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:HELGESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:ABRAHAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4637 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3527
Mailing Address - Country:US
Mailing Address - Phone:612-803-9979
Mailing Address - Fax:
Practice Address - Street 1:3501 ALDRICH AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-4149
Practice Address - Country:US
Practice Address - Phone:612-430-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
252Y00000X
ILAH05100316P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAH05100316POtherPROVIDER CONNECTIONS