Provider Demographics
NPI:1114214095
Name:STEFFENS, GARY LAWRENCE (LICSW)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LAWRENCE
Last Name:STEFFENS
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 1:5021 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-1844
Mailing Address - Country:US
Mailing Address - Phone:952-583-8901
Mailing Address - Fax:
Practice Address - Street 1:5021 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1844
Practice Address - Country:US
Practice Address - Phone:952-583-8901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical