Individual
JESSE INDERLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3700
(763) 559-5677
Mailing address
13895 INDUSTRIAL PARK BLVD, PLYMOUTH, MN 55441-3700
(763) 559-5677
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301412
MN
Other
Enumeration date
06/07/2011
Last updated
07/10/2012
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