Healthcare Provider Details

I. General information

NPI: 1962861583
Provider Name (Legal Business Name): RECOVERY PARTNERS, PC AT CHASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 HAZELTINE BLVD SUITE 300
CHASKA MN
55318-1009
US

IV. Provider business mailing address

1107 HAZELTINE BLVD SUITE 300
CHASKA MN
55318-1009
US

V. Phone/Fax

Practice location:
  • Phone: 651-213-4286
  • Fax: 651-213-4543
Mailing address:
  • Phone: 651-213-4286
  • Fax: 651-213-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARVIN SEPPALA
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 651-213-4825