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General NPI Number Information
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NPI Number | 1811757719
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Entity Type | Individual
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Provider Name | DIONE L WANGEN MSW, LGSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2024
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 412 19TH AVE SW STE 4
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City | WILLMAR
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State | MN
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Zip | 56201-5245
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Country | US
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Telephone | 320-403-4072
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Fax |
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Provider Business Mailing Address
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Address Line | 2109 4TH AVE SE
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City | WILLMAR
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State | MN
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Zip | 56201-3837
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Country | US
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Telephone | 132-090-5088
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29325
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License Number State | MN
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