Provider Demographics
NPI:1538704317
Name:VIAN, GLENDA MAE (LICSW)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MAE
Last Name:VIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:MAE
Other - Last Name:LOESCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 CAMPUS DR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-4845
Mailing Address - Country:US
Mailing Address - Phone:507-328-6400
Mailing Address - Fax:
Practice Address - Street 1:2100 CAMPUS DR SE STE 200
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-4845
Practice Address - Country:US
Practice Address - Phone:507-328-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN240461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical