Provider Demographics
NPI:1952552937
Name:CONRAD, DANIELLE MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:CONRAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:BOHLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3535 S 31ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3591
Mailing Address - Country:US
Mailing Address - Phone:701-780-6821
Mailing Address - Fax:701-780-1973
Practice Address - Street 1:3535 S 31ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3591
Practice Address - Country:US
Practice Address - Phone:701-780-6821
Practice Address - Fax:701-780-1973
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND36131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical