Individual
MELISSA M PRUDHOMME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
1132 CENTRAL AVE NE, MINNEAPOLIS, MN 55413-1512
(612) 902-5932
(612) 236-1701
Mailing address
1132 CENTRAL AVE NE, MINNEAPOLIS, MN 55413-1512
(612) 902-5932
(612) 236-1701
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302411
MN
Other
Enumeration date
05/22/2012
Last updated
05/22/2012
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