Healthcare Provider Details

I. General information

NPI: 1134053655
Provider Name (Legal Business Name): ROBYN JO WANKE LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10505 WAYZATA BLVD
MINNETONKA MN
55305-1502
US

IV. Provider business mailing address

10505 WAYZATA BLVD
MINNETONKA MN
55305-1502
US

V. Phone/Fax

Practice location:
  • Phone: 612-293-0513
  • Fax:
Mailing address:
  • Phone: 920-728-4214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number94392
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: