Individual
JODIE M EVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
206 MAPLE AVE E, MORA, MN 55051-1311
(320) 209-1941
Mailing address
665 5TH AVE NW, PINE CITY, MN 55063-1020
(320) 209-1941
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
306374
MN
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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