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General NPI Number Information
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NPI Number | 1689559312
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Entity Type | Organization
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Legal Business Name | LTC PROFESSIONALS, PLLC
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Dates
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Enumeration Date | 08/11/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 7801 E BUSH LAKE RD STE 400
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3113
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Country | US
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Telephone | 952-248-0716
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Fax |
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Provider Business Mailing Address
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Address Line | 7801 E BUSH LAKE RD STE 400
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City | MINNEAPOLIS
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State | MN
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Zip | 55439-3113
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Country | US
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Telephone | 952-248-0716
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | JESSIE RUSTAD
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Credential |
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Telephone | 507-351-8858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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