Most Relevant Information
Provider Data
| NPI Number: | 1003659962 |
| Provider Name: | KENNETH BACKEN LICENSED ADDICTION C |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: | 1973 |
Most Important Dates
| Enumeration Date: | 06/17/2024 |
| Last Updated: | 06/17/2024 |
Provider Practice Location
900 N BROADWAY STE 300
MINOT
ND
587032378
Practice Location Phone/Fax
| Phone: | 7015374191 |
| Fax: | 7017867174 |
Provider Mailing Location
900 N BROADWAY STE 111
MINOT
ND
587032378
Provider Mailing Phone/Fax
| Phone: | 7017202964 |
| Fax: | 7017867174 |