Provider Demographics
NPI:1447800800
Name:FENSKE, ELIZABETH RYAN (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RYAN
Last Name:FENSKE
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 1:6348 BELLEVUE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5200
Mailing Address - Country:US
Mailing Address - Phone:952-239-1447
Mailing Address - Fax:
Practice Address - Street 1:576 BIELENBERG DR STE 250
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1739
Practice Address - Country:US
Practice Address - Phone:866-821-0281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN284911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical