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General NPI Number Information
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NPI Number | 1215128707
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Entity Type | Organization
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Legal Business Name | DANGIE WELLNESS SERVICES P.A.
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 6347 UPLAND LN N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4005
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Country | US
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Telephone | 612-202-9085
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Fax | 763-422-8283
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Provider Business Mailing Address
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Address Line | 6347 UPLAND LANE N
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City | MAPLE GROVE
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State | MN
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Zip | 55311-4005
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Country | US
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Telephone | 612-202-9085
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Fax | 763-422-8283
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MS. LYNN MARIE MARRS
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Credential | LICSW
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Telephone | 612-202-9085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10921
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License Number State | MN
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