DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: LEO FRED VICKERMAN LADC

MEDICARE: LEO FRED VICKERMAN 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) Counselor302510MN

General Provider Information

NPI Number : 1548490048
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEO FRED VICKERMAN LADC
Provider Business Mailing Address
First Line : 1121 JACKSON ST NE
Second Line : SUITE 105
City : MINNEAPOLIS
State : MN
Zip : 55413-1672
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1132 CENTRAL AVE NE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55413-1512
Country : US
Telephone Number : 612-236-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2009
Last Update Date : 07/17/2009

Similar Medicare Providers

1972511434 — JAMES HALL LADC
Practice Location Address:
1132 CENTRAL AVE NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-977-1821
Practice Fax: 612-236-1700
1982831533 — SPECIALIZED TREATMENT SERVICES, INC.
Practice Location Address:
1132 CENTRAL AVE. NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-236-1700
Practice Fax: 612-236-1701
1730312158 — GRETCHEN MARYANNE NESS LPN
Practice Location Address:
1132 CENTRAL AVE NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-236-1700
Practice Fax: 612-236-1701
1053544270 — KIM MICHELLE PARKER ADC-T
Practice Location Address:
1132 CENTRAL AVE NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-236-1700
Practice Fax:
1558679225 — MRS. HOLLY JO WEBB LADC
Practice Location Address:
1132 CENTRAL AVE NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-236-1700
Practice Fax: 612-236-1701
1679858039 — SPECIALIZED TREATMENT SERVICES, INC.
Practice Location Address:
1132 CENTRAL AVE NE
MINNEAPOLIS, MN
55413-1512
Practice Phone: 612-236-1700
Practice Fax: 612-236-1701

Directions to “ LEO FRED VICKERMAN LADC” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.