Provider Demographics
NPI:1174268643
Name:TWINGSTROM, ANDRIA C (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:C
Last Name:TWINGSTROM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-4503
Mailing Address - Country:US
Mailing Address - Phone:176-356-7374
Mailing Address - Fax:
Practice Address - Street 1:2700 SNELLING AVE N STE 400
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1783
Practice Address - Country:US
Practice Address - Phone:763-210-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN202391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical