| Doctor Name: | DAVE JUNGWIRTH |
| NPI Number: | 1104170554 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 101YA0400X |
| Business Practice Address: | 1550 E 78th St Richfield, MN - 554234638 |
| Business Phone Number: | 6127672846 |
| Business Fax Number: | |
| Mailing Address: | 1550 E 78th St, RICHFIELD |
| State: | MN |
| Postal Code: | 554234638 |
| Phone Number: | 6127672846 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2012 |
| NPI Last Update Date: | 11/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 101YA0400X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |