Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 303990 | MN |
Y | 1041C0700X | Clinical Social Worker | 23792 | MN |
NPI | 1003468547 |
---|---|
Provider Name | Noah Rector |
First Address | Saint Paul, MN 55113-3721 |
Second Address | Saint Paul, MN 55113-3739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2019 |
Last Update Date | 06/03/2020 |