Provider Demographics
NPI:1114942950
Name:WINTZ, DOROTHY ELEANOR (MA, LP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:ELEANOR
Last Name:WINTZ
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:ELEANOR
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LP
Mailing Address - Street 1:1500 MCANDREWS RD W STE 201
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4445
Mailing Address - Country:US
Mailing Address - Phone:952-892-8495
Mailing Address - Fax:952-892-8496
Practice Address - Street 1:1500 MCANDREWS RD W STE 201
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4445
Practice Address - Country:US
Practice Address - Phone:952-892-8495
Practice Address - Fax:952-892-8496
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical