Provider Demographics
NPI:1821741406
Name:DUEVEL, ANN (LICSW, LADC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:DUEVEL
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 LINDY AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5926
Mailing Address - Country:US
Mailing Address - Phone:507-571-2933
Mailing Address - Fax:
Practice Address - Street 1:2077 LINDY AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5926
Practice Address - Country:US
Practice Address - Phone:507-571-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN281581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN28158OtherLICENSE
MN304854OtherLICENSE