Provider Demographics
NPI:1194377044
Name:STROM, ANN TERESA (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:TERESA
Last Name:STROM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:TERESA
Other - Last Name:LALIBERTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:701 DECATUR AVE N STE 109
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4363
Mailing Address - Country:US
Mailing Address - Phone:763-746-2425
Mailing Address - Fax:763-746-2401
Practice Address - Street 1:701 DECATUR AVE N STE 109
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4363
Practice Address - Country:US
Practice Address - Phone:763-746-2425
Practice Address - Fax:763-746-2401
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN255801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE