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General NPI Number Information
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NPI Number | 1770873143
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Entity Type | Individual
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Provider Name | PAMELA JEAN QUINN LAC
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Gender | Female
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 04/19/2011
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Provider Practice Location Address
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Address Line | 47 W 6TH ST
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City | GRAFTON
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State | ND
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Zip | 58237-1403
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Country | US
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Telephone | 701-741-3500
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Fax | 701-352-0424
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Provider Business Mailing Address
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Address Line | 47 W 6TH ST
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City | GRAFTON
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State | ND
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Zip | 58237-1403
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Country | US
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Telephone | 701-741-3500
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Fax | 701-352-0424
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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 | 1288
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License Number State | ND
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