Provider Demographics
NPI:1245619014
Name:WILHELM, TONYA (LICSW)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:WILHELM
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 1:16228 MAIN AVE SE STE 109
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-1789
Mailing Address - Country:US
Mailing Address - Phone:612-418-8697
Mailing Address - Fax:888-308-4056
Practice Address - Street 1:16228 MAIN AVE SE STE 109
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-1789
Practice Address - Country:US
Practice Address - Phone:612-418-8697
Practice Address - Fax:888-308-4056
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21746261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)