Individual provider · Type 1 NPI

Jason Martin Samudio

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

NPI number 1215494158 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 101YA0400X305317 (MN)

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

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About NPI 1215494158

Jason Martin Samudio's National Provider Identifier is 1215494158, issued on Feb 27, 2019. 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 Feb 27, 2019.