Provider Demographics
NPI:1578512588
Name:WOODRUFF, ANN LAURIE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LAURIE
Last Name:WOODRUFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:LAURIE
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3915 GOLDEN VALLEY RD
Mailing Address - Street 2:COURAGE CENTER
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4298
Mailing Address - Country:US
Mailing Address - Phone:763-520-0449
Mailing Address - Fax:763-520-0355
Practice Address - Street 1:3915 GOLDEN VALLEY RD
Practice Address - Street 2:COURAGE CENTER
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4298
Practice Address - Country:US
Practice Address - Phone:763-520-0449
Practice Address - Fax:763-520-0355
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
113269OtherBHP
113269OtherUCARE
MN520T5WOOtherBCBS
SD6570580Medicaid
6237995OtherMEDICA UBH
HP48062OtherHEALTH PARTNERS
1043156OtherPREFERRED ONE