Organization
AVALON STILLWARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VALERIE BUNDY (CONTROLLER)
(612) 326-7555
Entity
Organization
Contact information
Practice address
1825 CURVE CREST BLVD W STE 103, STILLWATER, MN 55082-6054
(612) 326-7555
Mailing address
550 MAIN ST, NEW BRIGHTON, MN 55112-3271
(612) 326-7555
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
830778
MN
Other
Enumeration date
05/09/2007
Last updated
08/22/2020
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