1720228356 NPI number — MR. MICHAEL EDWARD RIVARD LICSW

Table of content: MR. MICHAEL EDWARD RIVARD LICSW (NPI 1720228356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720228356 NPI number — MR. MICHAEL EDWARD RIVARD LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVARD
Provider First Name:
MICHAEL
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1720228356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
902 HIGHWAY 15 S STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55350-3506
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-587-4127
Provider Business Mailing Address Fax Number:
320-587-3886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
313 22ND AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARTELL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56377-2467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-224-1522
Provider Business Practice Location Address Fax Number:
320-255-7011
Provider Enumeration Date:
02/22/2009

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: 1041C0700X , with the licence number:  11796 , 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)





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