Individual
SIRI TS EIDSMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2118 BLAISDELL AVE, MINNEAPOLIS, MN 55404-2415
(651) 201-2758
Mailing address
13579 BERKSHIRE LN, EDEN PRAIRIE, MN 55347-1702
(218) 341-6835
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
306131
MN
104100000X
Social Worker
Primary
30140
MN
Other
Enumeration date
10/08/2021
Last updated
10/08/2021
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