Provider Demographics
NPI:1679300875
Name:STENDER, REGINA MAY (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:MAY
Last Name:STENDER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2441
Mailing Address - Country:US
Mailing Address - Phone:651-285-2625
Mailing Address - Fax:218-335-4410
Practice Address - Street 1:LEECH LAKE BEHAVIORAL HEALTH
Practice Address - Street 2:16123 GRANT UTLEY AVE. NW
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-3023
Practice Address - Fax:218-335-4410
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty