Healthcare Provider Details

I. General information

NPI: 1952594046
Provider Name (Legal Business Name): BETH M PREWETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35382 US HIGHWAY 2
GRAND RAPIDS MN
55744-4754
US

IV. Provider business mailing address

35382 US HIGHWAY 2
GRAND RAPIDS MN
55744-4754
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-4886
  • Fax: 218-327-4848
Mailing address:
  • Phone: 218-327-4886
  • Fax: 218-327-4848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: