Provider Demographics
NPI:1376969915
Name:TALBACKA, MANDI M (LCSW)
Entity Type:Individual
Prefix:
First Name:MANDI
Middle Name:M
Last Name:TALBACKA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 COLLEGE DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-1225
Mailing Address - Country:US
Mailing Address - Phone:701-751-3111
Mailing Address - Fax:
Practice Address - Street 1:1237 W DIVIDE AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-328-8888
Practice Address - Fax:701-328-8900
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical