1033445556 NPI number — MRS. CYNTHIA DIANE ENGELKES M.A., L.A.M.F.T.

Table of content: JEFFREY NICHOLAS WILLIAMS RPH (NPI 1295121820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033445556 NPI number — MRS. CYNTHIA DIANE ENGELKES M.A., L.A.M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGELKES
Provider First Name:
CYNTHIA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.A.M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENGELKES
Provider Other First Name:
CINDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033445556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7810 VICTORIA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-237-6415
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10505 WAYZATA BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-237-6415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1920 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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