Provider Demographics
NPI:1750741641
Name:NELSON-ANSLEY, PAIGE RENEE (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:RENEE
Last Name:NELSON-ANSLEY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HIGHWAY 7 APT 106
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55305-4732
Mailing Address - Country:US
Mailing Address - Phone:952-465-6170
Mailing Address - Fax:
Practice Address - Street 1:2600 FERNBROOK LN N STE 138
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-4752
Practice Address - Country:US
Practice Address - Phone:952-544-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical