MEDICARE: LADONNA STRANGE LADC, BES

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	301864	MN

General Provider Information

NPI Number	:	1912037276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LADONNA STRANGE LADC, BES

Provider Business Mailing Address
First Line	:	2027 S 6TH ST
Second Line	:	SUITE 203
City	:	BRAINERD
State	:	MN
Zip	:	56401-5500
Country	:	US
Telephone Number	:	218-838-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2027 S 6TH ST
Second Line	:	SUITE 203
City	:	BRAINERD
State	:	MN
Zip	:	56401-5500
Country	:	US
Telephone Number	:	218-838-5074
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/07/2008

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