Provider Demographics
NPI:1447552070
Name:ANDERSON, KAREN LOU (LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOU
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17645 JUNIPER PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7490
Mailing Address - Country:US
Mailing Address - Phone:651-313-8080
Mailing Address - Fax:
Practice Address - Street 1:7300 FRANCE AVE S
Practice Address - Street 2:SUITE 208
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4525
Practice Address - Country:US
Practice Address - Phone:952-913-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical