Provider Demographics
NPI:1205274990
Name:EMANUEL, ANNIE ELIZABETH (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 SLATER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4047
Mailing Address - Country:US
Mailing Address - Phone:651-882-6299
Mailing Address - Fax:651-683-0057
Practice Address - Street 1:4660 SLATER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4047
Practice Address - Country:US
Practice Address - Phone:651-882-6299
Practice Address - Fax:651-683-0057
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5978103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical