MEDICARE: ROBYN JO WANKE LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	94392	MN

General Provider Information

NPI Number	:	1134053655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN JO WANKE LGSW

Provider Business Mailing Address
First Line	:	10505 WAYZATA BLVD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1502
Country	:	US
Telephone Number	:	920-728-4214
Fax Number	:

Provider Business Practice Location Address
First Line	:	10505 WAYZATA BLVD
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1502
Country	:	US
Telephone Number	:	612-293-0513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2026
Last Update Date	:	06/10/2026

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