Individual
ALICE ETHEL NORDLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5842 OLD MAIN ST STE 2, NORTH BRANCH, MN 55056-6687
(651) 401-3068
(651) 674-2534
Mailing address
1175 N RYAN LAKE RD NE, ISANTI, MN 55040-6146
(763) 607-7284
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304361
MN
Other
Enumeration date
03/04/2018
Last updated
03/04/2018
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