Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 305362 | MN |
NPI | 1003372582 |
---|---|
Provider Name | Lindsey Rae Sommer |
First Address | Stillwater, MN 55082-5615 |
Second Address | Stillwater, MN 55082-5830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |