Provider Demographics
NPI:1295787125
Name:STEINKAMP, BRENDA (MA, LP, LICSW)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:STEINKAMP
Suffix:
Gender:F
Credentials:MA, LP, LICSW
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:WANKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:407 W 66TH ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2374
Practice Address - Country:US
Practice Address - Phone:612-798-8800
Practice Address - Fax:612-798-8833
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3300103T00000X
MN6847104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN