Individual
NICOLE MARIE BUSSERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
410 HAYWARD AVE N, OAKDALE, MN 55128-5379
(651) 777-4233
(651) 777-3507
Mailing address
410 HAYWARD AVE N, OAKDALE, MN 55128-5379
(651) 777-4233
(651) 777-3507
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
303446
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411707484
—
MN
Enumeration date
09/03/2015
Last updated
09/03/2015
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