Provider Demographics
NPI:1942778022
Name:RAATZ, MELISSA ANNE (MSW, LICSW, CHT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:RAATZ
Suffix:
Gender:F
Credentials:MSW, LICSW, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 RUCKS FARM RD
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-8837
Mailing Address - Country:US
Mailing Address - Phone:763-242-3261
Mailing Address - Fax:866-318-3073
Practice Address - Street 1:10505 WAYZATA BLVD STE 203-3
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1502
Practice Address - Country:US
Practice Address - Phone:763-242-3261
Practice Address - Fax:866-318-3073
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-07
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN34621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1710295001Medicaid