Healthcare Provider Details

I. General information

NPI: 1487786539
Provider Name (Legal Business Name): AYD & CAVANAGH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9007 KAGAN AVE NE
MONTICELLO MN
55362-4535
US

IV. Provider business mailing address

9007 KAGAN AVE NE
MONTICELLO MN
55362-4535
US

V. Phone/Fax

Practice location:
  • Phone: 612-229-1234
  • Fax: 763-295-4946
Mailing address:
  • Phone: 612-229-1234
  • Fax: 763-295-4946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLP4403
License Number StateMN

VIII. Authorized Official

Name: MICHELE BATKIEWICZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 612-710-3671