Provider Demographics
NPI:1942755541
Name:DANIELLE CONRAD, LICSW, PLLC
Entity Type:Organization
Organization Name:DANIELLE CONRAD, LICSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-738-0888
Mailing Address - Street 1:1165 S COLUMBIA RD STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4007
Mailing Address - Country:US
Mailing Address - Phone:701-738-0888
Mailing Address - Fax:866-345-4397
Practice Address - Street 1:1165 S COLUMBIA RD STE D
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4007
Practice Address - Country:US
Practice Address - Phone:701-738-0888
Practice Address - Fax:866-345-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND36131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty