| Doctor Name: | ANGELA MARIE CARLSON |
| NPI Number: | 1134574726 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 21884 |
| Business Practice Address: | 603 Bruce St Crookston, MN - 567162914 |
| Business Phone Number: | 2182813940 |
| Business Fax Number: | 2182816261 |
| Mailing Address: | Po Box 603, CROOKSTON |
| State: | MN |
| Postal Code: | 567160603 |
| Phone Number: | 2182813940 |
| Fax Number: | 2182816261 |
| NPI Enumeration Date: | 05/02/2016 |
| NPI Last Update Date: | 05/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 21884 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |