Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 302235 | MN |
NPI | 1003139494 |
---|---|
Provider Name | Jessica L Scott |
First Address | Bemidji, MN 56601-3196 |
Second Address | Bemidji, MN 56601-3196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2010 |
Last Update Date | 12/03/2010 |