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General NPI Number Information
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NPI Number | 1528923182
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Entity Type | Individual
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Provider Name | BYRON LEE JEFFERY LADC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1500 GOLDEN VALLEY RD
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-3139
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Country | US
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Telephone | 612-520-9168
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Fax | 612-520-0047
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Provider Business Mailing Address
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Address Line | 1500 GOLDEN VALLEY RD
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-3139
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Country | US
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Telephone | 612-520-9168
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Fax | 612-520-0047
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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 | 307056
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License Number State | MN
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