Healthcare Provider Details

I. General information

NPI: 1023948213
Provider Name (Legal Business Name): ERIC ROGER FORSLUND I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1917
US

IV. Provider business mailing address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1917
US

V. Phone/Fax

Practice location:
  • Phone: 763-688-8348
  • Fax: 763-688-8409
Mailing address:
  • Phone: 763-688-8348
  • Fax: 763-688-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number300904
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: