Provider Demographics
NPI:1013950203
Name:AFFELDT, WILLIAM J (MSSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:AFFELDT
Suffix:
Gender:M
Credentials:MSSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-1930
Mailing Address - Country:US
Mailing Address - Phone:763-684-3719
Mailing Address - Fax:637-581-9090
Practice Address - Street 1:1001 HART BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-8929
Practice Address - Country:US
Practice Address - Phone:763-295-2921
Practice Address - Fax:763-581-9090
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN42481041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
110573C851OtherUCARE
6248959OtherMEDICA
MN970757300Medicaid
HP27808OtherHEALTH PARTNERS
922241007835OtherPREFERRED ONE
922241007835OtherPREFERRED ONE