Provider Demographics
NPI:1174269658
Name:DELACRUZ, JADA (LADC)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:DELACRUZ
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003-1800
Mailing Address - Country:US
Mailing Address - Phone:507-229-0350
Mailing Address - Fax:507-216-0371
Practice Address - Street 1:1826 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003-1800
Practice Address - Country:US
Practice Address - Phone:507-229-0350
Practice Address - Fax:507-216-0371
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2754101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN306648OtherLADC LICENSE