Provider Demographics
NPI:1063463065
Name:MONGEAU, ANN HELEN (L AC)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:HELEN
Last Name:MONGEAU
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2205
Mailing Address - Country:US
Mailing Address - Phone:763-300-9811
Mailing Address - Fax:
Practice Address - Street 1:2150 3RD AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2206
Practice Address - Country:US
Practice Address - Phone:763-300-9811
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1190171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist