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General NPI Number Information
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NPI Number | 1245048263
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Entity Type | Individual
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Provider Name | JENNIFER MARIE NELSON LADC
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Gender | Female
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 101 DEHLER DR
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City | SARTELL
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State | MN
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Zip | 56377
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Country | US
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Telephone | 320-253-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-628-9566
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Fax | 651-628-0411
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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 | 304949
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License Number State |
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