Provider Demographics
NPI:1720278674
Name:DOW, JOHN HENRY (MA,ADC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENRY
Last Name:DOW
Suffix:
Gender:M
Credentials:MA,ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 NICOLLET AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1628
Mailing Address - Country:US
Mailing Address - Phone:612-871-7878
Mailing Address - Fax:612-871-2567
Practice Address - Street 1:2616 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1628
Practice Address - Country:US
Practice Address - Phone:612-871-7878
Practice Address - Fax:612-871-2567
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300024101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)