Healthcare Provider Details

I. General information

NPI: 1962175943
Provider Name (Legal Business Name): RIVER WALK COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 W LINCOLN AVE SUITE 104
FERGUS FALLS MN
56537
US

IV. Provider business mailing address

225 W LINCOLN AVE SUITE 104
FERGUS FALLS MN
56537
US

V. Phone/Fax

Practice location:
  • Phone: 218-531-1424
  • Fax: 218-531-1420
Mailing address:
  • Phone: 218-531-1424
  • Fax: 218-531-1420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MELISSA DAWN GEDROSE
Title or Position: OWNER
Credential: LICSW
Phone: 218-531-1424