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General NPI Number Information
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NPI Number | 1598053167
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Entity Type | Individual
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Provider Name | STEVEN WICKELGREN LMFT
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Gender | Male
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 14051 BURNHAVEN DR STE 105
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City | BURNSVILLE
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State | MN
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Zip | 55337-4400
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Country | US
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Telephone | 952-994-1198
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Fax |
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Provider Business Mailing Address
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Address Line | 14051 BURNHAVEN DR STE 105
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City | BURNSVILLE
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State | MN
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Zip | 55337-4400
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Country | US
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Telephone | 952-994-1198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2111
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License Number State | MN
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