Healthcare Provider Details

I. General information

NPI: 1306253380
Provider Name (Legal Business Name): BARBARA HOUSTON R.T. (R) C.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5691 WEDGEWOOD RD
BAXTER MN
56425-2904
US

IV. Provider business mailing address

5691 WEDGEWOOD RD
BAXTER MN
56425-2904
US

V. Phone/Fax

Practice location:
  • Phone: 218-330-8854
  • Fax:
Mailing address:
  • Phone: 218-330-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number14765
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: