Provider Demographics
NPI:1295133288
Name:MOVICK-ANDERSON, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:MOVICK-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1508
Mailing Address - Country:US
Mailing Address - Phone:763-274-0510
Mailing Address - Fax:763-441-3117
Practice Address - Street 1:907 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1508
Practice Address - Country:US
Practice Address - Phone:763-274-0510
Practice Address - Fax:763-441-3117
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical