FDL ADOLESCENT OUTPATIENT TX NPI 1447606959

NPI Information

  • NPI: 1447606959
  • Provider Name: FDL ADOLESCENT OUTPATIENT TX
  • Classification: Clinic/Center - 261QM0855X
  • Specialization: Adolescent and Children Mental Health
  • Entity Type: Organization
  • Former Legal Business Name: FOND DU LAC RESERVATION BUSINESS COMMITTEE
  • CLIA Number: 24D2151041
  • Address: 927 TRETTEL LN
    CLOQUET, MN
    ZIP 55720
  • Phone: (218) 879-1227

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NPI Details

FDL ADOLESCENT OUTPATIENT TX is an adolescent and children mental health clinic center in Cloquet, MN. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. FDL ADOLESCENT OUTPATIENT TX NPI is 1447606959. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Fond Du Lac Reservation Business Committee.

The provider's business location address is:

927 TRETTEL LN
CLOQUET, MN
ZIP 55720-345
Phone: (218) 879-1227

The provider's authorized official is Marilyn Grover .
The authorized official title is Associate Director and has the following contact phone number (218) 879-1227.

The CLIA number assigned to this NPI record is 24D2151041 - health fair with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/13/2016 and was last updated on 10/10/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1666815101MEDICAIDMINNESOTA
2666815100MEDICAIDMINNESOTA
38F27F0OTHERMINNESOTABCBS AODA
45985000001MEDICARE NSCMINNESOTA
5C06351MEDICARE PINMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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