Individual
LEO FRED VICKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1132 CENTRAL AVE NE, MINNEAPOLIS, MN 55413-1512
(612) 236-1700
Mailing address
1121 JACKSON ST NE, SUITE 105, MINNEAPOLIS, MN 55413-1672
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302510
MN
Other
Enumeration date
07/17/2009
Last updated
07/17/2009
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