Provider Demographics
NPI:1114708203
Name:HOOGENDOORN, EMILY GRACE MCNIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE MCNIEL
Last Name:HOOGENDOORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 NICOL WAY
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-2993
Mailing Address - Country:US
Mailing Address - Phone:209-815-6105
Mailing Address - Fax:
Practice Address - Street 1:7777 E FREEDOM RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-9694
Practice Address - Country:US
Practice Address - Phone:209-815-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1007451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical