Individual
ANGIE RACHELLE MARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
6017 BIRCHWOOD RD, WOODBURY, MN 55125-2007
(651) 354-5455
Mailing address
3817 PRAIRIE RD, WHITE BEAR LAKE, MN 55110-4837
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304564
MN
225200000X
Physical Therapy Assistant
—
—
Other
Enumeration date
09/18/2007
Last updated
09/03/2022
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