Individual
ROBERT FRANCIS SQUILLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LADC
Contact information
Practice address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 746-2392
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(651) 746-2392
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
304209
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304209
MN
Other
Enumeration date
07/29/2016
Last updated
08/16/2016
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