Individual
RAEGAN ROSE BISSONETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
303 1ST AVE NE STE 365, FARIBAULT, MN 55021-5297
(651) 304-0307
Mailing address
303 1ST AVE NE STE 365, FARIBAULT, MN 55021-5297
(651) 304-0307
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2775
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
07/05/2022
Last updated
07/05/2022
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