Healthcare Provider Details

I. General information

NPI: 1336825579
Provider Name (Legal Business Name): ROBERT RICHARD MENGE MSW, LGSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 LEXINGTON AVE N
ARDEN HILLS MN
55126-6164
US

IV. Provider business mailing address

14301 EWING AVE S
BURNSVILLE MN
55306-4885
US

V. Phone/Fax

Practice location:
  • Phone: 952-746-5350
  • Fax:
Mailing address:
  • Phone: 952-746-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29641
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: