MEDICARE: CHRISTINE RUSHFELDT LICSW, LADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	303042	MN
2	1041C0700X	Clinical Social Worker	21952	MN

General Provider Information

NPI Number	:	1659728848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE RUSHFELDT LICSW, LADC

Provider Business Mailing Address
First Line	:	2577 TERRITORIAL RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1500
Country	:	US
Telephone Number	:	612-373-2409
Fax Number	:	612-341-3294

Provider Business Practice Location Address
First Line	:	2577 TERRITORIAL RD
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1500
Country	:	US
Telephone Number	:	612-373-2409
Fax Number	:	612-341-3294

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

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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