Healthcare Provider Details

I. General information

NPI: 1710985114
Provider Name (Legal Business Name): HOPEALLIANZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 LANCASTER LN N SUITE 111
PLYMOUTH MN
55441-1700
US

IV. Provider business mailing address

4205 LANCASTER LN N SUITE 111
PLYMOUTH MN
55441-1700
US

V. Phone/Fax

Practice location:
  • Phone: 763-546-6624
  • Fax: 763-332-5006
Mailing address:
  • Phone: 763-546-6624
  • Fax: 763-332-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10662
License Number StateMN

VIII. Authorized Official

Name: DR. JODY L FRIESEN GRANDE
Title or Position: CEO
Credential: PHD
Phone: 763-546-6624