Healthcare Provider Details

I. General information

NPI: 1144183880
Provider Name (Legal Business Name): JAMIE NELSON MA, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37625 ELEANOR AVE
NORTH BRANCH MN
55056-5546
US

IV. Provider business mailing address

37625 ELEANOR AVE
NORTH BRANCH MN
55056-5546
US

V. Phone/Fax

Practice location:
  • Phone: 651-592-8556
  • Fax:
Mailing address:
  • Phone: 651-592-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number305654
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: