Healthcare Provider Details

I. General information

NPI: 1124932165
Provider Name (Legal Business Name): STEPHANIE FERGUSON LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 E SAINT GERMAIN ST
SAINT CLOUD MN
56304-0617
US

IV. Provider business mailing address

1425 E SAINT GERMAIN ST
SAINT CLOUD MN
56304-0617
US

V. Phone/Fax

Practice location:
  • Phone: 320-281-3718
  • Fax: 320-281-3718
Mailing address:
  • Phone: 320-281-3727
  • Fax: 320-281-3718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306591
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: