Healthcare Provider Details

I. General information

NPI: 1871338202
Provider Name (Legal Business Name): VIANNA SELENE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIANNA SCHERMERHORN

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 32ND ST S
FARGO ND
58103-6304
US

IV. Provider business mailing address

1411 32ND ST S STE 1
FARGO ND
58103-6304
US

V. Phone/Fax

Practice location:
  • Phone: 701-264-5200
  • Fax:
Mailing address:
  • Phone: 701-264-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6765
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: