Individual
LISA FAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 ANNE ST NW, BEMIDJI, MN 56601-6151
(218) 333-5000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
(605) 328-6585
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
306950
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
10/24/2023
Last updated
02/20/2025
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