Individual
MS. ELIZABETH BONIFACIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
7300 147TH ST W, APPLE VALLEY, MN 55124-7541
(952) 997-3020
Mailing address
7300 147TH ST W, APPLE VALLEY, MN 55124-7541
(952) 997-3020
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305421
MN
Other
Enumeration date
08/17/2022
Last updated
08/17/2022
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