Doctor Name: | MARY MARGARET GALES-WENZ |
NPI Number: | 1023166659 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 04518 |
Business Practice Address: | 9075 Quaday Ave Ne Suite 102 Otsego, MN - 553306672 |
Business Phone Number: | 7637469492 |
Business Fax Number: | 7637463685 |
Mailing Address: | 1900 Silver Lake Rd Nw, Suite 110 NEW BRIGHTON |
State: | MN |
Postal Code: | 551121786 |
Phone Number: | 6516289566 |
Fax Number: | 6516280411 |
NPI Enumeration Date: | 01/08/2007 |
NPI Last Update Date: | 08/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 04518 |
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 |