| Fetal Alcohol Diagnostic Program | |
|
5 N 3rd Ave W Suite 310 Duluth MN 55802 | |
| (218) 740-6700 | |
| (218) 740-6710 |
| Full Name | Fetal Alcohol Diagnostic Program |
|---|---|
| Speciality | Clinic/center |
| Location | 5 N 3rd Ave W, Duluth, Minnesota |
| Authorized Official Name and Position | Daniel L Svendsen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2183365702 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fetal Alcohol Diagnostic Program 130 W Superior St Suite 700 Duluth MN 55802 Ph: (218) 336-5700 | Fetal Alcohol Diagnostic Program 5 N 3rd Ave W Suite 310 Duluth MN 55802 Ph: (218) 740-6700 |
| NPI Number | 1790954279 |
|---|---|
| Provider Enumeration Date | 02/28/2008 |
| Last Update Date | 07/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790954279 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 174400000X | Specialist | 46825 (Minnesota) | Secondary |
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