MEDICARE: FAMILY SERVICE OF WINONA

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	8677	MN
2	104100000X	Social Worker	8882	MN
3	103T00000X	Psychologist	LP4439	MN
4	103T00000X	Psychologist	LP4392	MN
5	103T00000X	Psychologist	LP1219	MN
6	103T00000X	Psychologist	LP3132	MN
7	103T00000X	Psychologist	LP0177	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14809	OTHER		HEALTHPARTNERS
2	01015397	OTHER		PREFERRED ONE
3	57490FA	OTHER		BCBS
4	38076T0	OTHER		BCBS
5	E341	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1710986989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY SERVICE OF WINONA

Provider Business Mailing Address
First Line	:	66 E. 3RD STREET #201
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987
Country	:	US
Telephone Number	:	507-462-7292
Fax Number	:	507-457-9887

Provider Business Practice Location Address
First Line	:	66 E. 3RD STREET #201
Second Line	:
City	:	WINONA
State	:	MN
Zip	:	55987
Country	:	US
Telephone Number	:	507-462-7292
Fax Number	:	507-457-9887

Authorized Official
Title or Position	:	ADMIN MANAGER/THERAPIST
Name	:	MS. DIANE V. PETZ
Credential	:	MS/LP
Telephone Number	:	507-452-7292

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/11/2025

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Directions to “FAMILY SERVICE OF WINONA ” Practice Location

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