Provider Demographics
NPI:1124646138
Name:WESSELS, WHITNEY KELTNER (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:KELTNER
Last Name:WESSELS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 EAGLE POINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042
Mailing Address - Country:US
Mailing Address - Phone:612-361-9448
Mailing Address - Fax:563-228-4308
Practice Address - Street 1:8530 EAGLE POINT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8648
Practice Address - Country:US
Practice Address - Phone:763-328-0606
Practice Address - Fax:763-328-0606
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23464104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker