MEDICARE: SHELLEY RORVICK MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	16029	AZ
2	106H00000X	Marriage & Family Therapist	1061-124	WI
3	106H00000X	Marriage & Family Therapist	2756	MN

General Provider Information

NPI Number	:	1063896355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY RORVICK MA, LMFT

Provider Business Mailing Address
First Line	:	302 W SUPERIOR ST
Second Line	:	SUITE 508
City	:	DULUTH
State	:	MN
Zip	:	55802-5115
Country	:	US
Telephone Number	:	218-409-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	302 W SUPERIOR ST
Second Line	:	SUITE 508
City	:	DULUTH
State	:	MN
Zip	:	55802-5115
Country	:	US
Telephone Number	:	218-727-7353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	01/02/2024

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