Provider Demographics
NPI:1205994746
Name:SALO, ANNE LOUISE (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:LOUISE
Last Name:SALO
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 1:511 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-1631
Mailing Address - Country:US
Mailing Address - Phone:651-776-8804
Mailing Address - Fax:
Practice Address - Street 1:511 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-1631
Practice Address - Country:US
Practice Address - Phone:651-776-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN086571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6250816OtherMEDICA - UBH
MN807819000Medicaid
MN302P0SAOtherBLUE CROSS BLUE SHIELD
MNHP27122OtherHEALTH PARTNERS
MN263853OtherCOMPSYCH EAP