Provider Demographics
NPI:1194486951
Name:WYNNE, JOSETTE C (LICSW)
Entity type:Individual
Prefix:
First Name:JOSETTE
Middle Name:C
Last Name:WYNNE
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 1:11525 RIVER HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-3215
Mailing Address - Country:US
Mailing Address - Phone:612-578-7916
Mailing Address - Fax:
Practice Address - Street 1:C/O ASLAN INSTITUTE
Practice Address - Street 2:4141 OLD SIBLEY MEMORIAL HWY
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:612-578-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical