Provider Demographics
NPI:1679840912
Name:SMITH, ANITA LINNEA (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LINNEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-6511
Mailing Address - Country:US
Mailing Address - Phone:262-345-5560
Mailing Address - Fax:262-345-5531
Practice Address - Street 1:515 N RIVERFRONT DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3471
Practice Address - Country:US
Practice Address - Phone:800-438-1772
Practice Address - Fax:262-345-5531
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN515OtherLICENSE