Individual
CARLYE KUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1145 GRAND AVE, SAINT PAUL, MN 55105-2629
(612) 257-2391
Mailing address
1145 GRAND AVE, SAINT PAUL, MN 55105-2629
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
MN
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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