Provider Demographics
NPI:1144455817
Name:BACKMAN, VIRGINIA KAY (LICSW)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:KAY
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:GINNY
Other - Middle Name:KAY
Other - Last Name:BACKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:201 28TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-5241
Mailing Address - Country:US
Mailing Address - Phone:320-214-8558
Mailing Address - Fax:320-235-2733
Practice Address - Street 1:201 28TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-5241
Practice Address - Country:US
Practice Address - Phone:320-214-8558
Practice Address - Fax:320-235-2733
Is Sole Proprietor?:No
Enumeration Date:2009-05-23
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN153761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical