Provider Demographics
NPI:1700097474
Name:TRTANJ, FRANCINE H (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:FRANCINE
Middle Name:H
Last Name:TRTANJ
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 1:2870 MISSISSIPPI SHORES ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449
Mailing Address - Country:US
Mailing Address - Phone:218-851-8204
Mailing Address - Fax:218-828-4321
Practice Address - Street 1:2870 MISSISSIPPI SHORES RD
Practice Address - Street 2:
Practice Address - City:FORT RIPLEY
Practice Address - State:MN
Practice Address - Zip Code:56449
Practice Address - Country:US
Practice Address - Phone:218-851-8204
Practice Address - Fax:218-828-4321
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1700097474Medicaid
MN1700097474Medicaid