Healthcare Provider Details

I. General information

NPI: 1447084884
Provider Name (Legal Business Name): CRYSTA ROCHELE CADALBERT LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 LAGOON AVE FL 4
MINNEAPOLIS MN
55408-2885
US

IV. Provider business mailing address

1330 LAGOON AVE FL 4
MINNEAPOLIS MN
55408-2885
US

V. Phone/Fax

Practice location:
  • Phone: 651-243-2161
  • Fax:
Mailing address:
  • Phone: 651-243-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307129
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: