Individual
SIERRA BALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
360 PIERCE AVE STE 206, NORTH MANKATO, MN 56003-2250
(507) 229-0350
(507) 216-0371
Mailing address
360 PIERCE AVE STE 206, NORTH MANKATO, MN 56003-2250
(507) 229-0350
(507) 216-0371
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305653
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
305653
LADC LICENSE
MN
Enumeration date
04/07/2022
Last updated
04/07/2022
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