Provider Demographics
NPI:1679831705
Name:FLEMING, MINDY LEE (LICSW)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:LEE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:LEE
Other - Last Name:VOELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 LAFAYETTE RD N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55155-3802
Mailing Address - Country:US
Mailing Address - Phone:651-431-6634
Mailing Address - Fax:
Practice Address - Street 1:444 LAFAYETTE RD N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55155-3802
Practice Address - Country:US
Practice Address - Phone:651-431-6634
Practice Address - Fax:651-431-7601
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN199371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical