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Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Organization
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Active
Parent organization
FOND DU LAC HUMAN SERVICES DIVISION
Other names
FDL Human Services Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC HUMAN SERVICES DIVISION
Authorized official
JENNIFER DUPUIS (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Mailing address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
666815100
—
MN
05
—
666815101
—
MN
01
—
8F27FO
BCBS AODA
MN
Enumeration date
03/18/2016
Last updated
06/23/2020
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