Provider Demographics
NPI:1871186379
Name:KROSSCHELL, ANTHONY W (LADC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:KROSSCHELL
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 COLBY CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-4765
Mailing Address - Country:US
Mailing Address - Phone:612-695-7515
Mailing Address - Fax:
Practice Address - Street 1:800 PRAIRIE CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7306
Practice Address - Country:US
Practice Address - Phone:952-234-9206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304054101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)