Provider Demographics
NPI:1780177022
Name:NELSON, DANA (LADC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:NELSON
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 1:2550 UNIVERSITY AVE W STE 325S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1903
Mailing Address - Country:US
Mailing Address - Phone:888-709-9344
Mailing Address - Fax:888-990-2714
Practice Address - Street 1:2550 UNIVERSITY AVE W STE 325S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1903
Practice Address - Country:US
Practice Address - Phone:888-709-9344
Practice Address - Fax:888-990-2714
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303188101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)