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General NPI Number Information
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NPI Number | 1821550005
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Entity Type | Organization
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Legal Business Name | COSCARELLI CONSULTING, LLC
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Dates
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Enumeration Date | 04/04/2019
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1687 WOODLANE DR STE 2002
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City | WOODBURY
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State | MN
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Zip | 55125-3063
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Country | US
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Telephone | 507-951-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 9437 DUNES LN
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4681
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Country | US
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Telephone | 507-951-9980
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MELINDA RAE COSCARELLI
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Credential | PHD
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Telephone | 507-951-9980
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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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