MEDICARE: BARBARA LYNN WISNIEWSKI LPCC

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	101YM0800X	Mental Health Counselor	CC01905	MN

General Provider Information

NPI Number	:	1609471697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA LYNN WISNIEWSKI LPCC

Provider Business Mailing Address
First Line	:	10780 201ST AVE NW
Second Line	:
City	:	ELK RIVER
State	:	MN
Zip	:	55330-2068
Country	:	US
Telephone Number	:	612-408-5407
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S 2ND ST STE 125
Second Line	:
City	:	PRINCETON
State	:	MN
Zip	:	55371-1878
Country	:	US
Telephone Number	:	612-787-2212
Fax Number	:

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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