Provider Demographics
NPI:1346803038
Name:SCANLAN, ANNA D (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:D
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 CHURCHILL ST STE 220
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2274
Mailing Address - Country:US
Mailing Address - Phone:612-808-0953
Mailing Address - Fax:
Practice Address - Street 1:4570 CHURCHILL ST STE 220
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2274
Practice Address - Country:US
Practice Address - Phone:612-808-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3881106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist