Individual
KENNETH ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
43500 MIGIZI DR, ONAMIA, MN 56359-2241
(320) 532-4163
Mailing address
42273 TWILIGHT ROAD, ONAMIA, MN 56359
(320) 532-4427
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301420
MN
Other
Enumeration date
11/17/2011
Last updated
11/17/2011
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