MEDICARE: RICARDO ASCANO, LTD

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	103TC0700X	Clinical Psychologist	LP1190	MN

General Provider Information

NPI Number	:	1497751465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO ASCANO, LTD

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:
City	:	BRECKENRIDGE
State	:	MN
Zip	:	56520
Country	:	US
Telephone Number	:	218-643-3867
Fax Number	:	218-643-1630

Provider Business Practice Location Address
First Line	:	614 NEBRASKA AVE
Second Line	:
City	:	BRECKENRIDGE
State	:	MN
Zip	:	56520-1545
Country	:	US
Telephone Number	:	218-643-3867
Fax Number	:	218-643-1630

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. RICARDO P ASCANO JR.
Credential	:	PH.D.
Telephone Number	:	218-643-3867

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/22/2020

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