Provider Demographics
NPI:1659457596
Name:BEENKEN, MARTHA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BEENKEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 NICOLS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3425
Mailing Address - Country:US
Mailing Address - Phone:612-597-5986
Mailing Address - Fax:651-405-0358
Practice Address - Street 1:4655 NICOLS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2395
Practice Address - Country:US
Practice Address - Phone:612-597-5986
Practice Address - Fax:651-405-0358
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14040 LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP66834OtherFAM.COUNSEL, MH, BEHAVIOR