Provider Demographics
NPI:1790290658
Name:CAOUETTE, NANCY (LADC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CAOUETTE
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 1:1101 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1400
Mailing Address - Country:US
Mailing Address - Phone:952-234-6860
Mailing Address - Fax:952-854-5363
Practice Address - Street 1:1101 E 78TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1400
Practice Address - Country:US
Practice Address - Phone:952-234-6860
Practice Address - Fax:952-854-5363
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2056101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)