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General NPI Number Information
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NPI Number | 1225801228
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Entity Type | Individual
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Provider Name | COURTNEY HAM LADC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 529 WOODLEY ST W
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City | NORTHFIELD
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State | MN
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Zip | 55057-2765
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Country | US
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Telephone | 507-225-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 811 DIVISION ST S
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City | MORRISTOWN
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State | MN
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Zip | 55052-5122
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Country | US
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Telephone | 320-262-0515
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306708
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License Number State | MN
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