Provider Demographics
NPI:1831528413
Name:FRANK, GINA MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:FRANK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 15TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1911
Mailing Address - Country:US
Mailing Address - Phone:507-437-2827
Mailing Address - Fax:507-437-2829
Practice Address - Street 1:1403 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1911
Practice Address - Country:US
Practice Address - Phone:507-437-2827
Practice Address - Fax:507-437-2829
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302657101YA0400X
MN209991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)