Provider Demographics
NPI:1952500407
Name:LANDRUM, ANDREE KAY (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREE
Middle Name:KAY
Last Name:LANDRUM
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 1:756 DAYTON AVENUE
Mailing Address - Street 2:#4
Mailing Address - City:ST.PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7201
Mailing Address - Country:US
Mailing Address - Phone:651-290-2799
Mailing Address - Fax:651-290-2799
Practice Address - Street 1:756 DAYTON AVE
Practice Address - Street 2:#4
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-7201
Practice Address - Country:US
Practice Address - Phone:651-290-2799
Practice Address - Fax:651-290-2799
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker