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General NPI Number Information
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NPI Number | 1689541617
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Entity Type | Organization
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Legal Business Name | HOUSE OF JOEL
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 527 7TH AVE S
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4327
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Country | US
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Telephone | 507-318-3490
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Fax |
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Provider Business Mailing Address
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Address Line | 527 7TH AVE S
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City | SAINT CLOUD
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State | MN
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Zip | 56301-4327
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Country | US
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Telephone | 507-318-3490
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MARICUS LADELLE ROSEMAN
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Credential |
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Telephone | 507-318-3490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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