Individual
MR. BRADLEY A GANGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC, ADCR-MN CPRS
Contact information
Practice address
1516 W LAKE ST # 205, MINNEAPOLIS, MN 55408-2554
(612) 297-1804
Mailing address
1516 W LAKE ST # 205, MINNEAPOLIS, MN 55408-2554
(612) 297-1804
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305379
MN
225400000X
Rehabilitation Practitioner
10053940
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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