Healthcare Provider Details

I. General information

NPI: 1710986989
Provider Name (Legal Business Name): FAMILY SERVICE OF WINONA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 E. 3RD STREET #201
WINONA MN
55987
US

IV. Provider business mailing address

66 E. 3RD STREET #201
WINONA MN
55987
US

V. Phone/Fax

Practice location:
  • Phone: 507-462-7292
  • Fax: 507-457-9887
Mailing address:
  • Phone: 507-462-7292
  • Fax: 507-457-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4439
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP4392
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP1219
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP3132
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0177
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8677
License Number StateMN
# 7
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8882
License Number StateMN

VIII. Authorized Official

Name: MS. DIANE V. PETZ
Title or Position: ADMIN MANAGER/THERAPIST
Credential: MS/LP
Phone: 507-452-7292