Provider Demographics
NPI:1811993421
Name:AAGARD, CONSTANCE ANDERSON (MSED,)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ANDERSON
Last Name:AAGARD
Suffix:
Gender:F
Credentials:MSED,
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:JOAN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56619-1523
Mailing Address - Country:US
Mailing Address - Phone:218-634-1499
Mailing Address - Fax:218-634-4520
Practice Address - Street 1:106 8TH AVE. SE
Practice Address - Street 2:
Practice Address - City:BAUDETTE
Practice Address - State:MN
Practice Address - Zip Code:56623
Practice Address - Country:US
Practice Address - Phone:218-634-1499
Practice Address - Fax:218-634-4520
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 0390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8236590OtherSTATE TAX ID NUMBER
MN89G89ANOtherBC/BS IND ID NUMBER
MN2255394OtherCIGNA
MN6274671OtherUBH-MEDICA
MNHP118013OtherHEALTH PARTNERS