Provider Demographics
NPI:1467908277
Name:HINDERAKER, DANIEL JON (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JON
Last Name:HINDERAKER
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2127 COUNTY ROAD D E STE A100
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5350
Mailing Address - Country:US
Mailing Address - Phone:651-592-1592
Mailing Address - Fax:641-429-2988
Practice Address - Street 1:2127 COUNTY ROAD D E STE A
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5349
Practice Address - Country:US
Practice Address - Phone:651-592-1592
Practice Address - Fax:651-429-2988
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN227181041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical