Provider Demographics
NPI:1285870030
Name:ANEZ, ELIZABETH M (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:ANEZ
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BRIDGEWATER TRL
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7778
Mailing Address - Country:US
Mailing Address - Phone:715-497-6678
Mailing Address - Fax:
Practice Address - Street 1:1385 MENDOTA HEIGHTS RD STE 200
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-379-9800
Practice Address - Fax:651-405-0358
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN184771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical