Provider Demographics
NPI:1356013239
Name:CEKALLA, ANGELLA LYNN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELLA
Middle Name:LYNN
Last Name:CEKALLA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:ANGELLA
Other - Middle Name:LYNN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:2817 BEDOW RD
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1579
Mailing Address - Country:US
Mailing Address - Phone:218-849-0345
Mailing Address - Fax:651-431-7437
Practice Address - Street 1:11615 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7306
Practice Address - Country:US
Practice Address - Phone:218-849-0345
Practice Address - Fax:651-431-7437
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN218731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty