MEDICARE: MARC A LETENDRE MSED

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1497567507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC A LETENDRE MSED

Provider Business Mailing Address
First Line	:	1016 GRANDVIEW AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55812-1148
Country	:	US
Telephone Number	:	218-590-4030
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 W SUPERIOR ST STE 200
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-1939
Country	:	US
Telephone Number	:	218-606-1100
Fax Number	:

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

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/24/2025

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Directions to “ MARC A LETENDRE MSED” Practice Location

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