Provider Demographics
NPI:1437632718
Name:CASALE, AIMMY MARIE (LADC)
Entity Type:Individual
Prefix:
First Name:AIMMY
Middle Name:MARIE
Last Name:CASALE
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 1:1547 HAZELWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-1532
Mailing Address - Country:US
Mailing Address - Phone:651-329-4842
Mailing Address - Fax:
Practice Address - Street 1:3300 COUNTY ROAD 10 STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3064
Practice Address - Country:US
Practice Address - Phone:651-447-8643
Practice Address - Fax:763-999-4113
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304762101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty