Provider Demographics
NPI:1801275672
Name:MCDONALD, ANNE M (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:MCDONALD
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 1:7939 20TH AVENUE S
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-288-0332
Mailing Address - Fax:
Practice Address - Street 1:4444 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 235
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127
Practice Address - Country:US
Practice Address - Phone:651-289-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN187251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical