Active NPI
John Theodore Gudahl, LADC
- Addiction (Substance Use Disorder) Counselor
- Rochester, MN
National Provider Identifier
1114692092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 305754
- Practice address
- 300 11TH Ave NW Ste 112
Rochester, MN 55901-2739 - Phone
- (507) 216-6500
- NPI assigned
- Aug 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 305754 | MN | Primary |
Addresses
Primary practice location
300 11TH Ave NW Ste 112
Rochester, MN 55901-2739
Mailing address
5633 White Oaks LN NW
Rochester, MN 55901-3778
Phone (218) 341-4527
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 305754 | MN | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1628726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1628726400000",
"number": "1114692092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5633 WHITE OAKS LN NW",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559013778",
"telephone_number": "218-341-4527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 11TH AVE NW STE 112",
"city": "ROCHESTER",
"state": "MN",
"postal_code": "559012739",
"telephone_number": "507-216-6500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUDAHL",
"first_name": "JOHN",
"middle_name": "THEODORE",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-12",
"last_updated": "2021-08-12",
"certification_date": "2021-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "305754",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.