Healthcare Provider Details

I. General information

NPI: 1912381716
Provider Name (Legal Business Name): JOSEPH R HOOPS LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 WABASHA ST S SUITE 100
SAINT PAUL MN
55107-1819
US

IV. Provider business mailing address

9391 TURNBERRY ALCOVE
WOODBURY MN
55125-7714
US

V. Phone/Fax

Practice location:
  • Phone: 651-291-0067
  • Fax: 651-450-2221
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2079
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: