MEDICARE: CARRIE MICHELLE MCGREGOR 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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	300582	MN

General Provider Information

NPI Number	:	1578681060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MICHELLE MCGREGOR LADC

Provider Business Mailing Address
First Line	:	20509 ENFIELD AVE N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8138
Country	:	US
Telephone Number	:	651-464-6658
Fax Number	:	612-236-1701

Provider Business Practice Location Address
First Line	:	1121 JACKSON ST NE
Second Line	:	SUITE 105
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1672
Country	:	US
Telephone Number	:	612-236-1700
Fax Number	:	612-236-1701

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	06/18/2009

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