Individual
CHANTELLE NICOLE BORDELON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
15251 PLEASANT VALLEY RD, CENTER CITY, MN 55012-9640
(651) 213-4393
Mailing address
PO BOX 11, CENTER CITY, MN 55012-0011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304517
MN
Other
Enumeration date
01/30/2020
Last updated
01/30/2020
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