Provider Demographics
NPI:1144341504
Name:DOYLE, ANITA (MSW)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3754 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1277
Mailing Address - Country:US
Mailing Address - Phone:952-926-7063
Mailing Address - Fax:612-767-3776
Practice Address - Street 1:3754 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1277
Practice Address - Country:US
Practice Address - Phone:952-926-7063
Practice Address - Fax:612-767-3776
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN070501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5190550Medicaid