Provider Demographics
NPI:1912232703
Name:HIDLEBAUGH, ANDREA SUE (MSW LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:SUE
Last Name:HIDLEBAUGH
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 COMMERCE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4502
Mailing Address - Country:US
Mailing Address - Phone:651-399-8232
Mailing Address - Fax:
Practice Address - Street 1:680 COMMERCE DR STE 260
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-4502
Practice Address - Country:US
Practice Address - Phone:651-399-8232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-12
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN154841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical