Provider Demographics
NPI:1801539713
Name:FETT, VICTORIA LYNN (LGSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:FETT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-8526
Mailing Address - Country:US
Mailing Address - Phone:763-516-1834
Mailing Address - Fax:
Practice Address - Street 1:17685 JUNIPER PATH STE 303
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9821
Practice Address - Country:US
Practice Address - Phone:952-214-8959
Practice Address - Fax:952-214-8960
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN197001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical