Provider Demographics
NPI:1730696857
Name:NELSON, BRENDA A (BS, LADC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:BS, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ROBERT ST S STE 104
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1626
Mailing Address - Country:US
Mailing Address - Phone:651-493-9534
Mailing Address - Fax:651-340-5332
Practice Address - Street 1:155 WABASHA ST S STE 122
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1822
Practice Address - Country:US
Practice Address - Phone:651-227-8224
Practice Address - Fax:651-227-8210
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder