Provider Demographics
NPI:1497226799
Name:BOOS, ANITA MARIE (LADC)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:MARIE
Last Name:BOOS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 N FERRY ST
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1654
Mailing Address - Country:US
Mailing Address - Phone:763-310-7095
Mailing Address - Fax:
Practice Address - Street 1:2900 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-1390
Practice Address - Country:US
Practice Address - Phone:888-648-8349
Practice Address - Fax:651-348-8349
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303987101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)