Provider Demographics
NPI:1740504513
Name:DWORAKOSKI, DENISE LYNN (MA, LPC)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:LYNN
Last Name:DWORAKOSKI
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 GRAND AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2629
Mailing Address - Country:US
Mailing Address - Phone:612-554-9453
Mailing Address - Fax:
Practice Address - Street 1:311 RAMSEY ST # 205
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:612-554-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00384101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health