Provider Demographics
NPI:1720496797
Name:HERRICK, STEVE DONALD (LADC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:DONALD
Last Name:HERRICK
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 QUAIL ST
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1941
Mailing Address - Country:US
Mailing Address - Phone:612-454-2468
Mailing Address - Fax:651-459-2677
Practice Address - Street 1:140 QUAIL ST
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-1941
Practice Address - Country:US
Practice Address - Phone:612-454-2468
Practice Address - Fax:651-459-2677
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)