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Individual

MS. CAROLYN J NIESCHE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2520 N 2ND ST, MINNEAPOLIS, MN 55411-2200
(612) 521-4178
Mailing address
2520 N 2ND ST, MINNEAPOLIS, MN 55411-2200
(612) 521-4178

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
175T00000X
MN
Enumeration date
08/29/2019
Last updated
05/05/2021
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