Provider Demographics
NPI:1396964987
Name:WILKENING, CAROLINE BROOKS
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BROOKS
Last Name:WILKENING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:BROOKS
Other - Last Name:HOLDERNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 124
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2903
Mailing Address - Country:US
Mailing Address - Phone:952-835-7130
Mailing Address - Fax:952-831-1783
Practice Address - Street 1:5275 EDINA INDUSTRIAL BLVD STE 124
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2903
Practice Address - Country:US
Practice Address - Phone:952-835-7130
Practice Address - Fax:952-831-1783
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health