Individual
BROOKE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 TWELVE OAKS CENTER DR STE 662, WAYZATA, MN 55391-4525
(585) 478-0268
Mailing address
13784 CANDICE LN, EDEN PRAIRIE, MN 55346-3059
(585) 478-0268
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC02979
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
390200000X
—
MN
Enumeration date
07/28/2019
Last updated
09/07/2023
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