Individual
LORETTA JAYNE BACH GANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.A.D.C.
Contact information
Practice address
515 BRIDGE ST, PARK RAPIDS, MN 56470-1210
(218) 366-9229
(218) 237-2520
Mailing address
515 BRIDGE ST, PARK RAPIDS, MN 56470-1210
(218) 366-9229
(218) 237-2520
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300392
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164656989
LADC
MN
Enumeration date
05/07/2009
Last updated
02/20/2019
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