Provider Demographics
NPI:1386745776
Name:SELDEN, CONNIE S (MSW LICSW)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:S
Last Name:SELDEN
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 W 3RD AVE
Mailing Address - Street 2:RANGE MENTAL HEALTH CENTER INC
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746
Mailing Address - Country:US
Mailing Address - Phone:218-263-9237
Mailing Address - Fax:218-262-3150
Practice Address - Street 1:3203 W 3RD AVE
Practice Address - Street 2:RANGE MENTAL HEALTH CENTER PERPICH BUILDING
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746
Practice Address - Country:US
Practice Address - Phone:218-263-9237
Practice Address - Fax:218-262-3150
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical