Healthcare Provider Details

I. General information

NPI: 1578505582
Provider Name (Legal Business Name): COURTNEY M. ROONEY MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 WASHINGTON AVE
DETROIT LAKES MN
56501-3012
US

IV. Provider business mailing address

304 2ND AVE NE
PERHAM MN
56573-1817
US

V. Phone/Fax

Practice location:
  • Phone: 218-847-1676
  • Fax: 218-847-1678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15379
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: