Organization
FDL ADOLESCENT OUTPATIENT TX
Active
Parent organization
FOND DU LAC HUMAN SERVICES DIVISION
Other names
Fond du Lac Reservation Business Committee
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOND DU LAC HUMAN SERVICES DIVISION
Authorized official
MARILYN GROVER (ASSOCIATE DIRECTOR)
(218) 879-1227
Entity
Organization
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Mailing address
927 TRETTEL LN, CLOQUET, MN 55720-1345
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
666815100
—
MN
05
—
666815101
—
MN
01
—
8F27F0
BCBS AODA
MN
Enumeration date
05/13/2016
Last updated
10/10/2016
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us