Individual
MS. ROXANNE KIBBEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1695 EDGEMONT ST, MAPLEWOOD, MN 55117-2416
(443) 822-6747
Mailing address
1695 EDGEMONT ST, MAPLEWOOD, MN 55117-2416
(443) 822-6747
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300773
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300773
LICENSED ALCOHOL DRUG COUNSELOR
MN
Enumeration date
12/27/2018
Last updated
12/27/2018
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