Healthcare Provider Details

I. General information

NPI: 1932668795
Provider Name (Legal Business Name): INTERPERSONAL PSYCHOTHERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 3RD AVE SE STE 206
ROCHESTER MN
55904-4632
US

IV. Provider business mailing address

300 3RD AVE SE STE 206
ROCHESTER MN
55904-4632
US

V. Phone/Fax

Practice location:
  • Phone: 507-273-2316
  • Fax:
Mailing address:
  • Phone: 507-273-2316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MARILYN ROSE RILEY
Title or Position: CO-OWNER
Credential: APRN, CNS
Phone: 507-273-2316