Provider Demographics
NPI:1225164536
Name:HOOGLAND, CHANTELLE JESSICA (LPCC, LADC)
Entity Type:Individual
Prefix:MS
First Name:CHANTELLE
Middle Name:JESSICA
Last Name:HOOGLAND
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-3401
Mailing Address - Country:US
Mailing Address - Phone:952-388-9204
Mailing Address - Fax:
Practice Address - Street 1:250 PRAIRIE CENTER DR STE 202
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7911
Practice Address - Country:US
Practice Address - Phone:952-388-9204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304850101YA0400X
MNCC01230101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101076OtherDRUG MEDI-CAL BILLING #