Individual
DIETRICH ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2118 BLAISDELL AVE, MINNEAPOLIS, MN 55404-2415
(612) 235-6413
Mailing address
2118 BLAISDELL AVE, MINNEAPOLIS, MN 55404-2415
(612) 235-6413
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/23/2020
Last updated
04/01/2025
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