Provider Demographics
NPI:1720308943
Name:LUEBBERT, WAYNE JOSEPH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:JOSEPH
Last Name:LUEBBERT
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:1811 GREENVIEW PL SW STE 103
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4354
Practice Address - Country:US
Practice Address - Phone:507-536-7662
Practice Address - Fax:507-536-7664
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN159671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical