Provider Demographics
NPI:1588917504
Name:FLEMKE, SUE ELLEN (LICSW)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:FLEMKE
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 1:49045 180TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963-7602
Mailing Address - Country:US
Mailing Address - Phone:507-250-0287
Mailing Address - Fax:
Practice Address - Street 1:1880 AUSTIN RD
Practice Address - Street 2:SUITE2
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4543
Practice Address - Country:US
Practice Address - Phone:507-446-8123
Practice Address - Fax:507-446-0600
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN155161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical