1033274394 NPI number — MS. LINDSEY ABERLE HALLSTEN LAC LICENSED ADDICTI

Table of content: MS. LINDSEY ABERLE HALLSTEN LAC LICENSED ADDICTI (NPI 1033274394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033274394 NPI number — MS. LINDSEY ABERLE HALLSTEN LAC LICENSED ADDICTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLSTEN
Provider First Name:
LINDSEY
Provider Middle Name:
ABERLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LAC LICENSED ADDICTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033274394
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 23 ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-293-5429
Provider Business Mailing Address Fax Number:
701-293-0736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 2ND AVE NE
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-952-1250
Provider Business Practice Location Address Fax Number:
701-952-1252
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1551 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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