Healthcare Provider Details

I. General information

NPI: 1942854088
Provider Name (Legal Business Name): CAITLIN HOZENY LIENARD LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN HOZENY LICSW

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CENTRE POINTE BLVD STE 3
SAINT PAUL MN
55120-1271
US

IV. Provider business mailing address

5600 33RD AVE S
MINNEAPOLIS MN
55417-2806
US

V. Phone/Fax

Practice location:
  • Phone: 651-774-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25560
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: