Individual
JACOB FREDRICK VAN ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1811 WEIR DR STE 270, WOODBURY, MN 55125-6741
(651) 714-9646
(651) 714-9647
Mailing address
240 5TH ST E APT 313, SAINT PAUL, MN 55101-1874
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
305300
MN
Other
Enumeration date
07/01/2024
Last updated
07/01/2024
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