1407097025 NPI number — MR. DAVID ROBERT RYNDERS L.I.C.S.W.

Table of content: MR. DAVID ROBERT RYNDERS L.I.C.S.W. (NPI 1407097025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407097025 NPI number — MR. DAVID ROBERT RYNDERS L.I.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYNDERS
Provider First Name:
DAVID
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
L.I.C.S.W.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407097025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1407 SOUTH STATE ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ULM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-354-3181
Provider Business Mailing Address Fax Number:
507-354-3183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 DOWNTOWN PLAZA
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-735-8112
Provider Business Practice Location Address Fax Number:
507-235-8110
Provider Enumeration Date:
03/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LICSW#7581 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com