person
Jason Martin Samudio
Addiction (Substance Use Disorder) Counselor in Maple Grove, Minnesota
NPI 1215494158

Jason Martin Samudio is an Addiction (Substance Use Disorder) Counselor based in New Brighton, MN and is specialized in Addiction (Substance Use Disorder). Jason Martin Samudio practices in Maple Grove, MN. The NPI Number for Jason Martin Samudio is 1215494158 and holds a License No. 305317 (Minnesota).

The current practice location address for Jason Martin Samudio is 13603 80Th Cir N, Maple Grove, MN and can be reached out via phone at 763-274-3120 and via fax at 763-274-3121. You can also correspond with Jason Martin Samudio through the mailing address at 1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN - 55112-1789 (mailing address contact number: 651-628-9566).

Location: 13603 80Th Cir N, Maple Grove, MN, 55112-1789
person
Provider Profile Details
NPI Number
1215494158
Provider Name
Jason Martin Samudio
Credential
Provider Entity Type
Individual
Gender
Male
Address
13603 80Th Cir N, Maple Grove, MN, 55112-1789
Phone Number
763-274-3120
Fax Number
763-274-3121
Provider Enumeration Date
02/27/2019
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
13603 80Th Cir N
City
State
Zip
55369-8961
Phone Number
763-274-3120
Fax Number
763-274-3121
person
Provider Business Mailing Address Details
Address
1900 Silver Lake Rd Nw Ste 110
City
State
Zip
55112-1789
Phone Number
651-628-9566
Fax Number
651-628-0411
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
305317 (Minnesota)
Definition
Definition to come...
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