Individual
EDWARD WESLEY WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
8015 36TH AVE N APT 217, NEW HOPE, MN 55427-1960
(612) 636-0801
Mailing address
8015 36TH AVE N APT 217, NEW HOPE, MN 55427-1960
(612) 636-0801
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300517
MN
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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