| Fdl Adolescent Outpatient Tx | |
|
927 Trettel Ln Cloquet MN 55720-1345 | |
| (218) 879-1227 | |
| Not Available |
| Full Name | Fdl Adolescent Outpatient Tx |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 927 Trettel Ln, Cloquet, Minnesota |
| Authorized Official Name and Position | Marilyn Grover (ASSOCIATE DIRECTOR) |
| Authorized Official Contact | 2188791227 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fdl Adolescent Outpatient Tx 927 Trettel Ln Cloquet MN 55720-1345 Ph: () - | Fdl Adolescent Outpatient Tx 927 Trettel Ln Cloquet MN 55720-1345 Ph: (218) 879-1227 |
| NPI Number | 1447606959 |
|---|---|
| Provider Enumeration Date | 05/13/2016 |
| Last Update Date | 10/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447606959 | NPI | - | NPPES |
| 666815101 | Medicaid | MN | |
| 666815100 | Medicaid | MN | |
| 8F27F0 | Other | MN | BCBS AODA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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