Provider Demographics
NPI:1609471697
Name:WISNIEWSKI, BARBARA LYNN (LPCC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 201ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2068
Mailing Address - Country:US
Mailing Address - Phone:612-408-5407
Mailing Address - Fax:
Practice Address - Street 1:400 S 2ND ST STE 125
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1878
Practice Address - Country:US
Practice Address - Phone:612-787-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01905101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health