Provider Demographics
NPI:1346780939
Name:CALLAWAY, MAGAN ANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:MAGAN
Middle Name:ANNE
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MAGAN
Other - Middle Name:ANNE
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DENNIS
Mailing Address - Street 1:2586 7TH AVE E
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3083
Mailing Address - Country:US
Mailing Address - Phone:651-633-7300
Mailing Address - Fax:651-633-7301
Practice Address - Street 1:7401 METRO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3062
Practice Address - Country:US
Practice Address - Phone:612-447-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical