Active NPI
Jory Colegrove, MA LADC
- Addiction (Substance Use Disorder) Counselor
- Minneapolis, MN
National Provider Identifier
1730638644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 304459
- Practice address
- 1132 Central Ave NE
Minneapolis, MN 55413-1512 - Phone
- (612) 902-5928
- NPI assigned
- Oct 4, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 | 304459 | MN | Primary |
Addresses
Primary practice location
1132 Central Ave NE
Minneapolis, MN 55413-1512
Mailing address
1132 Central Ave NE
Minneapolis, MN 55413
Phone (612) 902-5928
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304459 | 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": "1475539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475539200000",
"number": "1730638644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1132 CENTRAL AVE NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55413",
"telephone_number": "612-902-5928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 CENTRAL AVE NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554131512",
"telephone_number": "612-902-5928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLEGROVE",
"first_name": "JORY",
"name_prefix": "Mr.",
"credential": "MA LADC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-04",
"last_updated": "2016-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "MN",
"license": "304459",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.