Provider Demographics
NPI:1962539031
Name:WARNKE, DARRELL (LICSW)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:WARNKE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 GILMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-2154
Mailing Address - Country:US
Mailing Address - Phone:507-459-0644
Mailing Address - Fax:
Practice Address - Street 1:1410 BUNDY BLVD
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6300
Practice Address - Country:US
Practice Address - Phone:507-452-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical