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NPI Code Detail

MEDICARE: MRS. HOLLY JO WEBB LADC

MEDICARE: MRS. HOLLY JO WEBB 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) Counselor301746MN

General Provider Information

NPI Number : 1558679225
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HOLLY JO WEBB LADC
Provider Business Mailing Address
First Line : 1061 DAYTON AVE
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-7297
Country : US
Telephone Number : 651-815-7814
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 : 612-236-1701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2010
Last Update Date : 09/04/2012

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Directions to “ MRS. HOLLY JO WEBB LADC” Practice Location

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