Healthcare Provider Details

I. General information

NPI: 1033479852
Provider Name (Legal Business Name): DAVID ANTHONY MUNSON LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH ST SE
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

1125 6TH ST SE P.O. BOX 787
WILLMAR MN
56201-4675
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-4613
  • Fax: 320-231-9141
Mailing address:
  • Phone: 320-235-4613
  • Fax: 320-231-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17227
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: