Provider Demographics
NPI:1255528329
Name:ANDSDOTTER CHARLOTTA CHARTERED
Entity type:Organization
Organization Name:ANDSDOTTER CHARLOTTA CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:IPSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:612-377-1701
Mailing Address - Street 1:2406 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-1013
Mailing Address - Country:US
Mailing Address - Phone:612-377-1701
Mailing Address - Fax:
Practice Address - Street 1:2406 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-1013
Practice Address - Country:US
Practice Address - Phone:612-377-1701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW 20751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty