Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 301150 | MN |
NPI | 1003466848 |
---|---|
Provider Name | Richard Dauer |
First Address | Saint Paul, MN 55116-1748 |
Second Address | Apple Valley, MN 55124-5300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2019 |
Last Update Date | 13/09/2019 |