Doctor Name: | MRS. MEGAN JADA RIES |
NPI Number: | 1033424858 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC,NCC,MS |
License Number: | LPC00778 |
Business Practice Address: | 166 Main St Winona, MN - 559873405 |
Business Phone Number: | 5074544341 |
Business Fax Number: | 5074536267 |
Mailing Address: | 166 Main Street, WINONA |
State: | MN |
Postal Code: | 559873405 |
Phone Number: | 5074544341 |
Fax Number: | 5074536267 |
NPI Enumeration Date: | 08/17/2010 |
NPI Last Update Date: | 08/17/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC00778 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |