Healthcare Provider Details

I. General information

NPI: 1548706369
Provider Name (Legal Business Name): REBECCA ANN REICHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA ANN REICHARD LICSW

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
US

IV. Provider business mailing address

1406 6TH AVE N
SAINT CLOUD MN
56303-1900
US

V. Phone/Fax

Practice location:
  • Phone: 320-229-2700
  • Fax: 320-200-3222
Mailing address:
  • Phone: 320-229-2700
  • Fax: 320-200-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number21409
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21409
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: