Healthcare Provider Details

I. General information

NPI: 1992216188
Provider Name (Legal Business Name): MICHAEL RAGUET LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

IV. Provider business mailing address

410 CHURCH ST SE
MINNEAPOLIS MN
55455-0222
US

V. Phone/Fax

Practice location:
  • Phone: 612-625-8400
  • Fax: 612-677-3321
Mailing address:
  • Phone: 612-624-8400
  • Fax: 612-677-3321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23097
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: