Individual
MR. JORY COLEGROVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LADC
Contact information
Practice address
1132 CENTRAL AVE NE, MINNEAPOLIS, MN 55413-1512
(612) 902-5928
Mailing address
1132 CENTRAL AVE NE, MINNEAPOLIS, MN 55413
(612) 902-5928
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304459
MN
Other
Enumeration date
10/04/2016
Last updated
10/04/2016
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