MEDICARE: MERRI CHRISTINE AHLSTROM LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	300759	MN

General Provider Information

NPI Number	:	1013848571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERRI CHRISTINE AHLSTROM LADC

Provider Business Mailing Address
First Line	:	701 DELLWOOD ST S
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-1917
Country	:	US
Telephone Number	:	763-688-8269
Fax Number	:	763-688-8409

Provider Business Practice Location Address
First Line	:	701 DELLWOOD ST S
Second Line	:
City	:	CAMBRIDGE
State	:	MN
Zip	:	55008-1917
Country	:	US
Telephone Number	:	763-688-8269
Fax Number	:	763-688-8409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2026
Last Update Date	:	05/26/2026

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