Individual
ANNETTE M HAVLICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
1756 RIDGEWOOD AVE, WHITE BEAR TOWNSHIP, MN 55110
(651) 400-0884
Mailing address
1756 RIDGEWOOD AVE, WHITE BEAR TOWNSHIP, MN 55110-5835
(651) 400-0884
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
225700000X
Massage Therapist
Primary
00006347
MN
Other
Enumeration date
02/23/2010
Last updated
08/25/2019
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