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NPI Code Detail

MEDICARE: BRANDYCE R EDSON LPCC, LADC

MEDICARE: BRANDYCE R EDSON LPCC, 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) Counselor304433
2101YP2500XProfessional CounselorCC02005MN

General Provider Information

NPI Number : 1447895065
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDYCE R EDSON LPCC, LADC
Provider Business Mailing Address
First Line : 675 E NICOLLET BLVD STE 250
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6768
Country : US
Telephone Number : 952-993-3307
Fax Number :
Provider Business Practice Location Address
First Line : 675 E NICOLLET BLVD STE 250
Second Line :
City : BURNSVILLE
State : MN
Zip : 55337-6768
Country : US
Telephone Number : 952-993-3307
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2019
Last Update Date : 12/11/2019

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