| Ili | |
|
2847 180th Ave Ne Ham Lake MN 55304-2664 | |
| (763) 413-6971 | |
| Not Available |
| Full Name | Ili |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2847 180th Ave Ne, Ham Lake, Minnesota |
| Authorized Official Name and Position | Mary Theresa Swenson (PRESIDENT) |
| Authorized Official Contact | 8585310710 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ili 13750 Crosstown Dr Nw #207 Andover MN 55304-5853 Ph: (858) 531-0710 | Ili 2847 180th Ave Ne Ham Lake MN 55304-2664 Ph: (763) 413-6971 |
| NPI Number | 1669873824 |
|---|---|
| Provider Enumeration Date | 09/08/2014 |
| Last Update Date | 09/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669873824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 00808 (Minnesota) | Primary |
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