Individual
KANDIA QUAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
414 11TH ST N, FARGO, ND 58102-4312
(701) 364-0743
Mailing address
600 S 2ND ST STE 308C, BISMARCK, ND 58504-5726
(701) 364-0743
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1482663
—
ND
Enumeration date
08/12/2021
Last updated
10/01/2021
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