Provider Demographics
NPI:1831684943
Name:CALLAIS, ANGELA (LGSW)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:CALLAIS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 HARMON PL STE 222C
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1903
Mailing Address - Country:US
Mailing Address - Phone:612-643-1341
Mailing Address - Fax:
Practice Address - Street 1:1624 HARMON PL STE 222C
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1903
Practice Address - Country:US
Practice Address - Phone:612-643-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker