Provider Demographics
NPI:1568268829
Name:BEATY, JODI (LADC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:BEATY
Suffix:
Gender:
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8590 EDINBURGH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3723
Mailing Address - Country:US
Mailing Address - Phone:763-425-5959
Mailing Address - Fax:763-425-5929
Practice Address - Street 1:8590 EDINBURGH CENTER DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3723
Practice Address - Country:US
Practice Address - Phone:763-425-5959
Practice Address - Fax:763-425-5929
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304412101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)