Provider Demographics
NPI:1902977143
Name:FLODSTROM, HELEN MAVIS (LADC)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:MAVIS
Last Name:FLODSTROM
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 1:402 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-1195
Mailing Address - Country:US
Mailing Address - Phone:320-843-3803
Mailing Address - Fax:
Practice Address - Street 1:222 9TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-2221
Practice Address - Country:US
Practice Address - Phone:320-763-3912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN301830101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)