Healthcare Provider Details

I. General information

NPI: 1104869049
Provider Name (Legal Business Name): RICARDO P. ASCANO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 E ALCOTT AVE
FERGUS FALLS MN
56537-2903
US

IV. Provider business mailing address

1005 MAIN ST
BRECKENRIDGE MN
56520-1011
US

V. Phone/Fax

Practice location:
  • Phone: 218-736-6987
  • Fax: 218-736-0734
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP1190
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberLP1190
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: