1972070373 NPI number — MRS. ANA DEAN PODRATZ MSW, LGSW

Table of content: MRS. ANA DEAN PODRATZ MSW, LGSW (NPI 1972070373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972070373 NPI number — MRS. ANA DEAN PODRATZ MSW, LGSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PODRATZ
Provider First Name:
ANA
Provider Middle Name:
DEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LGSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972070373
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 SILVER LAKE RD NW STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRIGHTON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55112-1789
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-379-1756
Provider Business Mailing Address Fax Number:
651-379-1738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 147TH ST W STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-7850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-997-3020
Provider Business Practice Location Address Fax Number:
952-997-3026
Provider Enumeration Date:
10/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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