Healthcare Provider Details

I. General information

NPI: 1568973840
Provider Name (Legal Business Name): ALLISON MAY WERNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 10/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7624 341ST ST
STACY MN
55079-9578
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW
SAINT PAUL MN
55112-1786
US

V. Phone/Fax

Practice location:
  • Phone: 651-414-1932
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: