Provider Demographics
NPI:1699913327
Name:TRENCH, ANN RS (MSSW, LICSW)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:RS
Last Name:TRENCH
Suffix:
Gender:F
Credentials:MSSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 LAKE ST S
Mailing Address - Street 2:SUITE 1Z
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2639
Mailing Address - Country:US
Mailing Address - Phone:651-464-2194
Mailing Address - Fax:651-464-5744
Practice Address - Street 1:1068 LAKE ST S
Practice Address - Street 2:SUITE 1Z
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2639
Practice Address - Country:US
Practice Address - Phone:651-464-2194
Practice Address - Fax:651-464-5744
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN137671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical