Healthcare Provider Details

I. General information

NPI: 1588574529
Provider Name (Legal Business Name): MORGAN RIIS MITTELSTAEDT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 1ST AVE N STE 150
MOORHEAD MN
56560-0002
US

IV. Provider business mailing address

20496 GADWALL LN
ROGERS MN
55374-8767
US

V. Phone/Fax

Practice location:
  • Phone: 218-228-3296
  • Fax:
Mailing address:
  • Phone: 763-913-5934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: