Basic Information
| Provider Information | |||||||||
| NPI: | 1336208503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WING | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | M.A., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 ZANE AVE N | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554431814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637628800 | ||||||||
| FaxNumber: | 7633154669 | ||||||||
| Practice Location | |||||||||
| Address1: | 6363 FRANCE AVE S STE 200 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9522309100 | ||||||||
| FaxNumber: | 9529222525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 1812 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1336208503 | 05 | MN | MEDICAID | 2191290 | 01 | MN | COMPSYCH EAP | OTHER | 1336208503 | 01 | MN | HEALTH PARTNERS | OTHER | 1336208503 | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |