Provider Demographics
NPI:1194235861
Name:VANDERLINDEN-WANG, GRETCHEN JANE (LICSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JANE
Last Name:VANDERLINDEN-WANG
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 IOWA AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3357
Mailing Address - Country:US
Mailing Address - Phone:651-216-1096
Mailing Address - Fax:
Practice Address - Street 1:HENNEPIN COUNTY MEDICAL CENTER ADULT PSYCHIATRY CLINIC
Practice Address - Street 2:701 PARK AVENUE, SHAPIRO BUILDING, SUITE S1.110
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415
Practice Address - Country:US
Practice Address - Phone:612-873-2218
Practice Address - Fax:612-873-1614
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN204461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical