Healthcare Provider Details

I. General information

NPI: 1912113358
Provider Name (Legal Business Name): JOHN RIGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE 2ND AVE
GRAND RAPIDS MN
55744-3615
US

IV. Provider business mailing address

215 SE 2ND AVE
GRAND RAPIDS MN
55744-3615
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-1151
  • Fax: 218-326-8255
Mailing address:
  • Phone: 218-327-1151
  • Fax: 218-326-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: