Provider Demographics
NPI:1184265225
Name:MUSICH, ANGELA MARIE
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:MARIE
Last Name:MUSICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:MARIE MUSICH
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE # MC961
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-219-9557
Mailing Address - Fax:612-466-9402
Practice Address - Street 1:4556 46TH AVE S APT 403
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4441
Practice Address - Country:US
Practice Address - Phone:612-219-9557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN238001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104100000XMedicaid