Individual
PENELOPE IVY NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
132 1ST AVE SE, WINNEBAGO, MN 56098-1052
(612) 877-0276
Mailing address
132 1ST AVE SE, WINNEBAGO, MN 56098-1052
(612) 877-0276
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305553
MN
Other
Enumeration date
10/14/2021
Last updated
10/14/2021
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