Provider Demographics
NPI:1457009029
Name:VILHAUER, ANDREA LYNN (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LYNN
Last Name:VILHAUER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:721 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4903
Mailing Address - Country:US
Mailing Address - Phone:701-461-7330
Mailing Address - Fax:701-239-2406
Practice Address - Street 1:721 1ST AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4903
Practice Address - Country:US
Practice Address - Phone:701-461-7330
Practice Address - Fax:701-239-2406
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5686104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker