Provider Demographics
NPI:1366049975
Name:ARNDT-WENGER, NICOLE M (LICSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:ARNDT-WENGER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ARNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1540 LAKE ST S
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-2628
Mailing Address - Country:US
Mailing Address - Phone:651-241-1517
Mailing Address - Fax:
Practice Address - Street 1:3900 NORTHWOODS DR
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-6966
Practice Address - Country:US
Practice Address - Phone:651-787-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN260791041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical