Provider Demographics
NPI:1164114302
Name:FROST, CANDACE (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:FROST
Suffix:
Gender:F
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 UNIVERSITY AVE W STE 203
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-3838
Mailing Address - Country:US
Mailing Address - Phone:612-440-6018
Mailing Address - Fax:
Practice Address - Street 1:1600 UNIVERSITY AVE W STE 203
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3838
Practice Address - Country:US
Practice Address - Phone:612-440-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN792941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical