Individual
JACOB R POPPINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
13045 FALCON DR STE 7404TH, BAXTER, MN 56425-4201
(218) 821-4538
Mailing address
1415 S 6TH ST, BRAINERD, MN 56401-4347
(218) 821-4538
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305402
MN
Other
Enumeration date
10/19/2020
Last updated
10/19/2020
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