Provider Demographics
NPI:1811757719
Name:WANGEN, DIONE L (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:DIONE
Middle Name:L
Last Name:WANGEN
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-3837
Mailing Address - Country:US
Mailing Address - Phone:132-090-5088
Mailing Address - Fax:
Practice Address - Street 1:412 19TH AVE SW STE 4
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5245
Practice Address - Country:US
Practice Address - Phone:320-403-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN293251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical