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Addiction Substance Use Disorder

Saint Paul, Minnesota

Provider NPI: 1740288893

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
Tel: 651-224-6200  Fax: 651-221-0457

Business Mailing Address:
Tel: 612-529-8874  Fax: 612-529-2050

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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