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General NPI Number Information
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NPI Number | 1760155519
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Entity Type | Individual
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Provider Name | CHANNA KAY DUMPPROPE BS, LADC
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Gender | Female
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 11 2ND ST SW STE 1
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City | WADENA
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State | MN
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Zip | 56482-1483
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Country | US
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Telephone | 218-631-1714
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Fax |
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Provider Business Mailing Address
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Address Line | 11 2ND ST SW STE 1
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City | WADENA
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State | MN
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Zip | 56482-1483
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Country | US
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Telephone | 218-631-1714
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Fax | 218-249-1506
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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 | 304925
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License Number State | MN
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