Healthcare Provider Details

I. General information

NPI: 1780454256
Provider Name (Legal Business Name): SHELLEY RORVICK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 WEST SUPERIOR STREET 508 LONSDALE BUILDING
DULUTH MN
55802-5115
US

IV. Provider business mailing address

302 WEST SUPERIOR STREET 508 LONSDALE BUILDING
DULUTH MN
55802-5115
US

V. Phone/Fax

Practice location:
  • Phone: 218-409-6456
  • Fax:
Mailing address:
  • Phone: 218-409-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY RORVICK
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: MA, LMFT
Phone: 218-409-6456