Individual provider · Type 1 NPI

Kimberly Fothergill

Addiction (Substance Use Disorder) Counselor · Maple Grove, MN

NPI number 1124533369 Active

Practice location

13603 80th Cir N
Maple Grove, MN 55369-8961

Call (763) 274-3120 Map

Fax (763) 274-3121

Mailing address

1900 Silver Lake Rd NW Ste 110
New Brighton, MN 55112-1789

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400XNone listed

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1124533369

Kimberly Fothergill's National Provider Identifier is 1124533369, issued on Dec 11, 2017. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Maple Grove, MN. The record was last updated on Oct 22, 2018.