Provider Demographics
NPI:1881814895
Name:MENK, CARRIE H (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:H
Last Name:MENK
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 1:401 DIVISION STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2096
Mailing Address - Country:US
Mailing Address - Phone:507-649-7294
Mailing Address - Fax:507-333-6484
Practice Address - Street 1:401 DIVISION STREET
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2096
Practice Address - Country:US
Practice Address - Phone:507-649-7294
Practice Address - Fax:507-333-6484
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN148661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical