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NPI Code Detail

MEDICARE: MRS. KAY RENEE TELLINGHUISEN LADC

MEDICARE: MRS. KAY RENEE TELLINGHUISEN 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) Counselor300644MN

General Provider Information

NPI Number : 1891937074
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KAY RENEE TELLINGHUISEN LADC
Provider Business Mailing Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 612-721-5551
Fax Number :
Provider Business Practice Location Address
First Line : 1501 XERXES AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-2851
Country : US
Telephone Number : 612-721-5551
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2009
Last Update Date : 04/02/2009

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