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General NPI Number Information
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NPI Number | 1063930238
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Entity Type | Individual
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Provider Name | SEAN THOMAS HIGGINS LADC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 11615 STATE AVE
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City | BRAINERD
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State | MN
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Zip | 56401-7306
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Country | US
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Telephone | 218-855-8767
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Fax | 651-431-7437
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Provider Business Mailing Address
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Address Line | 11615 STATE AVE
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City | BRAINERD
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State | MN
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Zip | 56401-7306
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Country | US
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Telephone | 218-855-8767
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Fax | 651-431-7437
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 116734
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5148
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304904
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4890
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License Number State | SD
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