MEDICARE: DANGIE WELLNESS SERVICES P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10921	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215128707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANGIE WELLNESS SERVICES P.A.

Provider Business Mailing Address
First Line	:	6347 UPLAND LANE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-4005
Country	:	US
Telephone Number	:	612-202-9085
Fax Number	:	763-422-8283

Provider Business Practice Location Address
First Line	:	6347 UPLAND LN N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55311-4005
Country	:	US
Telephone Number	:	612-202-9085
Fax Number	:	763-422-8283

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. LYNN MARIE MARRS
Credential	:	LICSW
Telephone Number	:	612-202-9085

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	06/05/2024

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