Healthcare Provider Details

I. General information

NPI: 1831826593
Provider Name (Legal Business Name): GEORGES W PROSPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAVOUX RD
CHASKA MN
55318-1328
US

IV. Provider business mailing address

700 RAVOUX RD
CHASKA MN
55318-1328
US

V. Phone/Fax

Practice location:
  • Phone: 256-755-1582
  • Fax:
Mailing address:
  • Phone: 256-755-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114615
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: