Provider Demographics
NPI:1386341758
Name:STAFFORD, ANIKA N
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:N
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 GRENADIER AVE N
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-4313
Mailing Address - Country:US
Mailing Address - Phone:651-492-5826
Mailing Address - Fax:
Practice Address - Street 1:7525 MITCHELL RD STE 100
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-1900
Practice Address - Country:US
Practice Address - Phone:612-924-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health