Provider Demographics
NPI:1588909758
Name:WILLIAMS-WENGERD, ANNE MARIE (MA)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:WILLIAMS-WENGERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:ENDERSBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 PORTLAND AVE
Mailing Address - Street 2:MC 965
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1533
Mailing Address - Country:US
Mailing Address - Phone:612-685-7084
Mailing Address - Fax:612-677-6248
Practice Address - Street 1:525 PORTLAND AVE
Practice Address - Street 2:MC 965
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1533
Practice Address - Country:US
Practice Address - Phone:612-685-7084
Practice Address - Fax:612-677-6248
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5199103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling