Provider Demographics
NPI:1093321101
Name:USELDINGER, MEGYN RENEE (LICSW)
Entity Type:Individual
Prefix:
First Name:MEGYN
Middle Name:RENEE
Last Name:USELDINGER
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 1:3535 S 31ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3593
Mailing Address - Country:US
Mailing Address - Phone:701-780-6821
Mailing Address - Fax:701-780-1973
Practice Address - Street 1:3535 S 31ST ST STE 201
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3593
Practice Address - Country:US
Practice Address - Phone:701-780-6821
Practice Address - Fax:701-780-1973
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker