Provider Demographics
NPI:1598053167
Name:WICKELGREN, STEVEN (LMFT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WICKELGREN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14051 BURNHAVEN DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4400
Mailing Address - Country:US
Mailing Address - Phone:952-994-1198
Mailing Address - Fax:
Practice Address - Street 1:14051 BURNHAVEN DR STE 105
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4400
Practice Address - Country:US
Practice Address - Phone:952-994-1198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist