Healthcare Provider Details

I. General information

NPI: 1003882838
Provider Name (Legal Business Name): LORETTA J. FENSKE L.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

IV. Provider business mailing address

10488 N SHORE DR
SPICER MN
56288-9568
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-4399
  • Fax:
Mailing address:
  • Phone: 320-796-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0404
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: