Doctor Name: | RENEE ANN FASTEEN |
NPI Number: | 1346669678 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LICSW |
License Number: | 19090 |
Business Practice Address: | 1339 Pelican Ln Detroit Lakes, MN - 565012726 |
Business Phone Number: | 2188478572 |
Business Fax Number: | |
Mailing Address: | 13686 W Lake Sallie Dr, DETROIT LAKES |
State: | MN |
Postal Code: | 565017104 |
Phone Number: | 2182054764 |
Fax Number: | |
NPI Enumeration Date: | 04/15/2014 |
NPI Last Update Date: | 04/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 19090 |
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 |