Healthcare Provider Details

I. General information

NPI: 1457009029
Provider Name (Legal Business Name): ANDREA LYNN VILHAUER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LYNN MOORE LMSW

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 1ST AVE N
FARGO ND
58102-4903
US

IV. Provider business mailing address

721 1ST AVE N
FARGO ND
58102-4903
US

V. Phone/Fax

Practice location:
  • Phone: 701-461-7330
  • Fax: 701-239-2406
Mailing address:
  • Phone: 701-461-7330
  • Fax: 701-239-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5686
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: