MEDICARE: DARCY STIVLAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	28711	MN

General Provider Information

NPI Number	:	1700342029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARCY STIVLAND

Provider Business Mailing Address
First Line	:	105 NEW ENGLAND PL STE 150
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-2036
Country	:	US
Telephone Number	:	651-304-4117
Fax Number	:	651-342-2361

Provider Business Practice Location Address
First Line	:	105 NEW ENGLAND PL STE 150
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-2036
Country	:	US
Telephone Number	:	651-304-4117
Fax Number	:	651-342-2361

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	11/14/2022

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Directions to “ DARCY STIVLAND ” Practice Location

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