Healthcare Provider Details

I. General information

NPI: 1366049975
Provider Name (Legal Business Name): NICOLE M ARNDT-WENGER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ARNDT

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NORTHWOODS DR
ARDEN HILLS MN
55112-6966
US

IV. Provider business mailing address

1540 LAKE ST S
FOREST LAKE MN
55025-2628
US

V. Phone/Fax

Practice location:
  • Phone: 651-787-9600
  • Fax:
Mailing address:
  • Phone: 651-241-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26079
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number26079
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: