1194235861 NPI number — GRETCHEN JANE VANDERLINDEN-WANG LICSW

Table of content: GRETCHEN JANE VANDERLINDEN-WANG LICSW (NPI 1194235861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194235861 NPI number — GRETCHEN JANE VANDERLINDEN-WANG LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDERLINDEN-WANG
Provider First Name:
GRETCHEN
Provider Middle Name:
JANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194235861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
988 IOWA AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55117-3357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-216-1096
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HENNEPIN COUNTY MEDICAL CENTER ADULT PSYCHIATRY CLINIC
Provider Second Line Business Practice Location Address:
701 PARK AVENUE, SHAPIRO BUILDING, SUITE S1.110
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-873-2218
Provider Business Practice Location Address Fax Number:
612-873-1614
Provider Enumeration Date:
10/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  20446 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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