Healthcare Provider Details

I. General information

NPI: 1609430958
Provider Name (Legal Business Name): FRAZIER RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 MARIE AVE
SOUTH ST PAUL MN
55075-2039
US

IV. Provider business mailing address

PO BOX 142
COTTAGE GROVE MN
55016-0142
US

V. Phone/Fax

Practice location:
  • Phone: 651-895-4440
  • Fax: 651-413-2877
Mailing address:
  • Phone: 651-895-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH FRANCES REZEK
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LICSW, LADC
Phone: 651-895-4440