Individual
KELSEY DALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
391 4TH AVE S, BAYPORT, MN 55003-1465
(320) 522-1582
Mailing address
391 4TH AVE S, BAYPORT, MN 55003-1465
(320) 522-1582
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304110
MN
Other
Enumeration date
01/31/2020
Last updated
01/31/2020
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