Healthcare Provider Details

I. General information

NPI: 1740759000
Provider Name (Legal Business Name): MICHELLE LYNN WENGE CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 04/24/2024
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 S BUR OAK PL STE 208
SIOUX FALLS SD
57108-2238
US

IV. Provider business mailing address

5024 S BUR OAK PL STE 208
SIOUX FALLS SD
57108-2238
US

V. Phone/Fax

Practice location:
  • Phone: 605-274-3333
  • Fax: 605-274-3111
Mailing address:
  • Phone: 605-274-3333
  • Fax: 605-274-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5094
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: