MEDICARE: DARCY WENNES LICSW

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	19467	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410900656	OTHER	MN	TAX ID

General Provider Information

NPI Number	:	1275082752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARCY WENNES LICSW

Provider Business Mailing Address
First Line	:	2713 ITASCA DR
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-5556
Country	:	US
Telephone Number	:	507-420-5671
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WARREN ST STE 304
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-3762
Country	:	US
Telephone Number	:	507-420-5671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	01/27/2022

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