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General NPI Number Information
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NPI Number | 1417154220
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Entity Type | Organization
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Legal Business Name | ANOKA COUNTY JUVENILE CENTER
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7555 4TH AVE
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City | LINO LAKES
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State | MN
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Zip | 55014-1068
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Country | US
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Telephone | 651-783-7502
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Fax | 651-783-8160
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Provider Business Mailing Address
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Address Line | 7555 4TH AVE
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City | LINO LAKES
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State | MN
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Zip | 55014-1068
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Country | US
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Telephone | 651-783-7502
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Fax | 651-783-8160
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Authorized Official
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Title or Position | ADMINISTRATIVE SUPERVISOR
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Name | MS. SUSAN MELINDA MOSER
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Credential |
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Telephone | 651-783-7502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1036841-1-CRF
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License Number State | MN
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