Provider Demographics
NPI:1013794676
Name:STOLTZMAN, NOAH
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:STOLTZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56065-8301
Mailing Address - Country:US
Mailing Address - Phone:507-327-6264
Mailing Address - Fax:
Practice Address - Street 1:7300 147TH ST W STE 600
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4517
Practice Address - Country:US
Practice Address - Phone:952-997-3020
Practice Address - Fax:952-997-3026
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306337101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)