Active NPI
Candice Jean Nadler, MA LP
- Counseling Psychologist
- Minnetonka, MN
National Provider Identifier
1720156219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- LP4625
- Practice address
- 13100 Wayzata Blvd
Minnetonka, MN 55305-1802 - Phone
- (952) 546-0616
- Fax
- (952) 593-1778
- NPI assigned
- Dec 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | LP4625 | MN | Primary |
Addresses
Primary practice location
13100 Wayzata Blvd
Minnetonka, MN 55305-1802
Mailing address
2509 Kelly Ave
Excelsior, MN 55331-9574
Phone (952) 212-0275
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14D87NA 4H557GI LLP | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP4625 | MN | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720156219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2509 KELLY AVE",
"city": "EXCELSIOR",
"state": "MN",
"postal_code": "553319574",
"telephone_number": "952-212-0275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13100 WAYZATA BLVD",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553051802",
"telephone_number": "952-546-0616",
"fax_number": "952-593-1778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NADLER",
"first_name": "CANDICE",
"middle_name": "JEAN",
"credential": "MA LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MN",
"license": "LP4625",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "14D87NA 4H557GI LLP",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.