Individual
MR. JEREMY SHANE VAN TASSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1112 7TH ST NW, ROCHESTER, MN 55901-1732
(507) 289-2089
Mailing address
343 WOODLAKE DR SE, ROCHESTER, MN 55904-6242
(507) 289-2089
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
306946
MN
Other
Enumeration date
02/15/2024
Last updated
02/15/2024
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