Provider Demographics
NPI:1700342029
Name:STIVLAND, DARCY
Entity Type:Individual
Prefix:
First Name:DARCY
Middle Name:
Last Name:STIVLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NEW ENGLAND PL STE 150
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-2036
Mailing Address - Country:US
Mailing Address - Phone:651-304-4117
Mailing Address - Fax:651-342-2361
Practice Address - Street 1:105 NEW ENGLAND PL STE 150
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-2036
Practice Address - Country:US
Practice Address - Phone:651-304-4117
Practice Address - Fax:651-342-2361
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN287111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical