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General NPI Number Information
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NPI Number | 1164829925
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Entity Type | Organization
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Legal Business Name | CEDAR VALLEY CENTER FOR CHILD & FAMILY THERAPY
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 7675 MN 13 W
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City | SAVAGE
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State | MN
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Zip | 55378
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Country | US
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Telephone | 763-229-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 3460 WASHINGTON DR SUITE 110
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City | EAGAN
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State | MN
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Zip | 55122-1338
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | MEGAN OUDEKERK
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Credential |
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Telephone | 763-229-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | MN
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