Healthcare Provider Details

I. General information

NPI: 1457495327
Provider Name (Legal Business Name): DIOCESE OF ST. CLOUD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 7TH AVE N STE 100
SAINT CLOUD MN
56303-3633
US

IV. Provider business mailing address

305 7TH AVE N STE 100
SAINT CLOUD MN
56303-3633
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-4721
  • Fax: 320-258-7658
Mailing address:
  • Phone: 320-252-4721
  • Fax: 320-258-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINE CODDEN
Title or Position: DIRECTOR
Credential:
Phone: 320-252-4721