Provider Demographics
NPI:1629337043
Name:GRETHEN, DANA MARIE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:MARIE
Last Name:GRETHEN
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 1:245 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3467
Mailing Address - Country:US
Mailing Address - Phone:612-870-3787
Mailing Address - Fax:612-870-3789
Practice Address - Street 1:245 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3467
Practice Address - Country:US
Practice Address - Phone:612-870-3787
Practice Address - Fax:612-870-3789
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN189811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical