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NPI Code Detail

MEDICARE: STENSON FEARS ADC

MEDICARE: STENSON FEARS ADC
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) Counselor301338MN

General Provider Information

NPI Number : 1194915041
Entity Type Code : Individual
Provider Name (Legal Business Name) : STENSON FEARS ADC
Provider Business Mailing Address
First Line : 2616 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1628
Country : US
Telephone Number : 612-871-7878
Fax Number : 612-871-2567
Provider Business Practice Location Address
First Line : 2616 NICOLLET AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55408-1628
Country : US
Telephone Number : 612-871-7878
Fax Number : 612-871-2567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 07/26/2007

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Directions to “ STENSON FEARS ADC” Practice Location

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