Provider Demographics
NPI:1275082752
Name:WENNES, DARCY (LICSW)
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:WENNES
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 ITASCA DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5556
Mailing Address - Country:US
Mailing Address - Phone:507-420-5671
Mailing Address - Fax:
Practice Address - Street 1:100 WARREN ST STE 304
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3762
Practice Address - Country:US
Practice Address - Phone:507-420-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN194671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410900656OtherTAX ID