| Doctor Name: | DR. CAROLE ANNE WIDICK |
| NPI Number: | 1770501843 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P. |
| License Number: | LP1899 |
| Business Practice Address: | 110 2nd St S Ste 301 Waite Park, MN - 563871314 |
| Business Phone Number: | 3202522976 |
| Business Fax Number: | 3206561570 |
| Mailing Address: | 110 2nd St S Ste 301, WAITE PARK |
| State: | MN |
| Postal Code: | 563871314 |
| Phone Number: | 3202522976 |
| Fax Number: | 3206561570 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 05/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | LP1899 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |