Provider Demographics
NPI:1255014700
Name:HOVERSTEN, CANDACE MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:HOVERSTEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-9436
Mailing Address - Country:US
Mailing Address - Phone:320-339-1930
Mailing Address - Fax:
Practice Address - Street 1:261 ATLANTIC AVE W
Practice Address - Street 2:
Practice Address - City:DASSEL
Practice Address - State:MN
Practice Address - Zip Code:55325-2208
Practice Address - Country:US
Practice Address - Phone:320-583-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN287341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical