Provider Demographics
NPI:1730300765
Name:MEDIATION SERVICES FOR ANOKA COUNTY
Entity Type:Organization
Organization Name:MEDIATION SERVICES FOR ANOKA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALLERSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-422-8878
Mailing Address - Street 1:2520 COON RAPIDS BLVD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3908
Mailing Address - Country:US
Mailing Address - Phone:763-422-8878
Mailing Address - Fax:763-422-0808
Practice Address - Street 1:2520 COON RAPIDS BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-3908
Practice Address - Country:US
Practice Address - Phone:763-422-8878
Practice Address - Fax:763-422-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable