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NPI Code Detail

MEDICARE: DANIEL KNUDSON LADC

MEDICARE: DANIEL KNUDSON 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
1101YA0400XAddiction (Substance Use Disorder) CounselorMN

General Provider Information

NPI Number : 1033546445
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL KNUDSON LADC
Provider Business Mailing Address
First Line : 1900 SILVER LAKE RD NW
Second Line : SUITE 110
City : NEW BRIGHTON
State : MN
Zip : 55112-1786
Country : US
Telephone Number : 651-628-9566
Fax Number :
Provider Business Practice Location Address
First Line : 13603 80TH CIR N
Second Line :
City : MAPLE GROVE
State : MN
Zip : 55369-8961
Country : US
Telephone Number : 763-274-3120
Fax Number : 763-274-3121
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2013
Last Update Date : 04/01/2015

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