Healthcare Provider Details

I. General information

NPI: 1104929785
Provider Name (Legal Business Name): SALOME DYANE HOFF-MCFARLANE MSW LCSW LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SALOME DYANE HOFF-MCFARLANE MSW LCSW LGSW

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 4TH ST S FARGO
FARGO ND
58104
US

IV. Provider business mailing address

1228 7TH ST N MOORHEAD
MOORHEAD MN
56560
US

V. Phone/Fax

Practice location:
  • Phone: 701-476-7200
  • Fax: 701-280-5795
Mailing address:
  • Phone: 701-476-7816
  • Fax: 701-476-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3526
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15279
License Number StateMN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: