Provider Demographics
NPI:1457178477
Name:LANDOWSKI, ELISHA ANN (LGSW)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:ANN
Last Name:LANDOWSKI
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 91ST AVE N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-3978
Mailing Address - Country:US
Mailing Address - Phone:715-310-7650
Mailing Address - Fax:
Practice Address - Street 1:10650 RED CIRCLE DR STE 103
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9184
Practice Address - Country:US
Practice Address - Phone:952-491-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN32133104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker