Basic Information
| Provider Information | |||||||||
| NPI: | 1538342746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIDTHUNE | ||||||||
| FirstName: | ANDREEN | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 W BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559875216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074547711 | ||||||||
| FaxNumber: | 5074520325 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 W BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 559875216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5074547711 | ||||||||
| FaxNumber: | 5074520325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 01/02/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1140 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.