Provider Demographics
NPI:1740349109
Name:WILLAND, TONA LOIS (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:TONA
Middle Name:LOIS
Last Name:WILLAND
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 1:2745 HAMLINE AVENUE NORTH
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:612-845-8197
Mailing Address - Fax:
Practice Address - Street 1:762 TRANSFER RD
Practice Address - Street 2:SUITE 21
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1404
Practice Address - Country:US
Practice Address - Phone:612-845-8197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN130411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN265435100Medicaid
MN265435100Medicaid