Individual
THERESA MARY ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
14949 62ND ST N, STILLWATER, MN 55082-6102
(651) 430-6617
Mailing address
14949 62ND ST N, STILLWATER, MN 55082-6102
(651) 430-6617
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304754
MN
Other
Enumeration date
02/02/2021
Last updated
02/02/2021
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