Individual
BRENDA WIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
1617 HWY 12 E, SUITE 230, WILLMAR, MN 56201
(320) 894-2741
(320) 205-0030
Mailing address
1617 HIGHWAY 12 E STE 230, WILLMAR, MN 56201-5816
(320) 894-2741
(320) 205-0030
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
8625
MN
1041C0700X
Clinical Social Worker
Primary
8625
MN
Other
Enumeration date
08/01/2014
Last updated
08/01/2014
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