Provider Demographics
NPI:1598296840
Name:ANDERSON, ASHLEY LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 3RD ST N STE 4
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-0003
Mailing Address - Country:US
Mailing Address - Phone:320-253-4120
Mailing Address - Fax:320-253-4179
Practice Address - Street 1:411 3RD ST N STE 4
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-0003
Practice Address - Country:US
Practice Address - Phone:320-253-4120
Practice Address - Fax:320-253-4179
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical