Provider Demographics
NPI:1780196964
Name:WEINKE, TAMMY JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:WEINKE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 CITY WALK DR UNIT 432
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-6953
Mailing Address - Country:US
Mailing Address - Phone:320-428-3525
Mailing Address - Fax:
Practice Address - Street 1:10300 CITY WALK DR UNIT 432
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-6953
Practice Address - Country:US
Practice Address - Phone:320-428-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6640-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional