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General NPI Number Information
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NPI Number | 1619473147
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Entity Type | Organization
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Legal Business Name | PEARL CONSULTING LLC
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 04/03/2018
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Provider Practice Location Address
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Address Line | 623 2ND ST SW
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City | STEWARTVILLE
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State | MN
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Zip | 55976-1160
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Country | US
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Telephone | 507-206-9689
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 332
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City | STEWARTVILLE
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State | MN
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Zip | 55976-0332
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Country | US
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Telephone | 507-206-9689
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | STEPHANIE ANN KRUGER
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Credential | CRC
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Telephone | 507-206-9689
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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 | 1092907-1-HCBS
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License Number State | MN
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