Renee Ann Fasteen, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

19090 Issued in MN

Practice address

1339 Pelican LN
Detroit Lakes, MN 56501-2726

Phone

(218) 847-8572

NPI assigned

Apr 15, 2014

Last updated

Apr 15, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lakes Crisis & Resource Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Detroit Lakes, MN
  • NPI 1720344286
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397520000000",
    "number": "1346669678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13686 W LAKE SALLIE DR",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565017104",
            "telephone_number": "218-205-4764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1339 PELICAN LN",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565012726",
            "telephone_number": "218-847-8572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FASTEEN",
        "first_name": "RENEE",
        "middle_name": "ANN",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-15",
        "last_updated": "2014-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "19090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle R England, MSW
• Cynthia Englehart
• Benjamin B Evenson, CRNA
• Elizabeth Evenson, PSY.D., LP
• Robert Fairbanks
• FCSL Detroit Lakes, LLC (Diamond Willow Assisted Living of Detroit Lakes)
• FCSL Detroit Lakes, LLC (Diamond Willow Assisted Living of Detroit Lakes)
• Paige Nicole Feist, APRN,CNP
• Zachary Fennell
• Michael Edgar Ferber, LP LICSW

• Clinical Social Worker in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.