Provider Information for 1558874768
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STACEY LYNN TWEEDT LADC
Sex: Female
NPI: 1558874768
Last Updated: 2024-10-10
Certification Date: 2024-10-10
Certification Date: 2024-10-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1558874768 | ||||||||||||
| Enumeration Date | 2017-11-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1119 GRANT ST JACKSON, MN 56143-1207 United States Phone: 507-841-2574 | Fax: | ||||||||||||
| Primary Practice Address | 1119 GRANT ST JACKSON, MN 56143-1207 United States Phone: 507-407-2177 | Fax:507-540-1135 | ||||||||||||
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