Provider Demographics
NPI:1720156219
Name:NADLER, CANDICE JEAN (MA LP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:JEAN
Last Name:NADLER
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9574
Mailing Address - Country:US
Mailing Address - Phone:952-212-0275
Mailing Address - Fax:
Practice Address - Street 1:13100 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1802
Practice Address - Country:US
Practice Address - Phone:952-546-0616
Practice Address - Fax:952-593-1778
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4625103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN14D87NA 4H557GI LLPOtherBLUE CROSS BLUE SHIELD