Individual
DALE BOTHUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
570 ASBURY ST STE 300, SAINT PAUL, MN 55104-1851
(651) 644-8515
(651) 644-3451
Mailing address
570 ASBURY ST STE 300, SAINT PAUL, MN 55104-1851
(651) 644-8515
(651) 644-3451
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24553
MN
Other
Enumeration date
03/25/2020
Last updated
03/25/2020
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