Individual
TRICIA BASTIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
607 4TH ST S, WALKER, MN 56484-6400
(218) 251-1365
Mailing address
PO BOX 910, WALKER, MN 56484-0910
(218) 251-1365
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1098115
MN
Other
Enumeration date
02/12/2019
Last updated
02/12/2019
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