Individual
CORRIE JOESPH PELTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
31065 FOREST BLVD., STACY, MN 55079
(650) 408-7121
Mailing address
PO BOX 30, STACY, MN 55079-0030
(651) 408-7121
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1032392-1-CDT
MN
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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