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NPI Code Detail

MEDICARE: COLIN KELLY FAULKNER II

MEDICARE:   COLIN KELLY FAULKNER II
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) Counselor

General Provider Information

NPI Number : 1881009306
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLIN KELLY FAULKNER II
Provider Business Mailing Address
First Line : 1246 UNIVERSITY AVE W
Second Line :
City : SAINT PAUL
State : MN
Zip : 55104-4125
Country : US
Telephone Number : 651-558-9522
Fax Number :
Provider Business Practice Location Address
First Line : 796 CAPITOL HTS
Second Line :
City : SAINT PAUL
State : MN
Zip : 55103-1852
Country : US
Telephone Number : 651-558-9522
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 06/23/2014

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Directions to “ COLIN KELLY FAULKNER II ” Practice Location

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