Individual
DIANE RUTH ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
4432 CHICAGO AVE, MINNEAPOLIS, MN 55407-3519
(612) 870-2439
(612) 870-2403
Mailing address
4738 BRYANT AVE N, MINNEAPOLIS, MN 55430-3535
(612) 388-6716
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
301252
MN
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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