Provider Demographics
NPI:1962386284
Name:WIMPFHEIMER, CRYSTAL (LICSW)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WIMPFHEIMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13182 RANCH RD NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-8709
Mailing Address - Country:US
Mailing Address - Phone:763-291-7260
Mailing Address - Fax:
Practice Address - Street 1:400 JACKSON AVE NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-3926
Practice Address - Country:US
Practice Address - Phone:763-308-5081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN214451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical