Organization
ABIJAH'S HOPE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA MARIE PEDERSON LICSW (CLINICAL DIRECTOR)
(320) 219-3192
Entity
Organization
Contact information
Practice address
12058 55TH ST N, STILLWATER, MN 55082-2029
(715) 379-1370
Mailing address
12058 55TH ST N, STILLWATER, MN 55082-2029
(715) 379-1370
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
21186
MN
Other
Enumeration date
01/18/2015
Last updated
01/18/2015
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