Provider Demographics
NPI:1467082099
Name:WESSELINK, TAMI YVONNE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:YVONNE
Last Name:WESSELINK
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 1:117 S SPRING ST # 686
Mailing Address - Street 2:
Mailing Address - City:LUVERNE
Mailing Address - State:MN
Mailing Address - Zip Code:56156-1916
Mailing Address - Country:US
Mailing Address - Phone:507-935-2111
Mailing Address - Fax:
Practice Address - Street 1:1210 5TH AVE
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-2432
Practice Address - Country:US
Practice Address - Phone:507-372-2155
Practice Address - Fax:507-372-2179
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health