Individual
DANIELA ALEJANDRA BONILLA BERMUDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
6200 EXCELSIOR BLVD STE 203, ST LOUIS PARK, MN 55416-2734
(952) 548-9354
(952) 925-3264
Mailing address
6200 EXCELSIOR BLVD STE 203, ST LOUIS PARK, MN 55416-2734
(952) 548-9354
(952) 925-3264
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304119
MN
Other
Enumeration date
04/12/2016
Last updated
04/12/2016
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