Provider Demographics
NPI:1609109255
Name:SPLADY, ANNA LARUE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LARUE
Last Name:SPLADY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 2ND ST
Mailing Address - Street 2:STE 421
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-1928
Mailing Address - Country:US
Mailing Address - Phone:218-302-5440
Mailing Address - Fax:
Practice Address - Street 1:205 W 2ND ST
Practice Address - Street 2:STE 421
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1928
Practice Address - Country:US
Practice Address - Phone:218-302-5440
Practice Address - Fax:218-302-5442
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN800002831Medicare PIN