Provider Demographics
NPI:1093570541
Name:ANDERSON, CANDACE JEAN (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:JEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:JEAN
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2497 7TH AVE E STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2946
Mailing Address - Country:US
Mailing Address - Phone:651-769-6400
Mailing Address - Fax:651-769-6449
Practice Address - Street 1:2497 7TH AVE E STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2946
Practice Address - Country:US
Practice Address - Phone:651-769-6400
Practice Address - Fax:651-769-6449
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN299811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical