Provider Demographics
NPI:1437178738
Name:HVASS, CONSTANCE MCLEOD (PHD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:MCLEOD
Last Name:HVASS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 HOLLY LN N
Mailing Address - Street 2:#2
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-1783
Mailing Address - Country:US
Mailing Address - Phone:763-205-1641
Mailing Address - Fax:612-342-2606
Practice Address - Street 1:2915 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2145
Practice Address - Country:US
Practice Address - Phone:612-834-0424
Practice Address - Fax:612-342-2606
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical