Healthcare Provider Details

I. General information

NPI: 1619807120
Provider Name (Legal Business Name): RYLEE FERN KUBISCHTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E BROADWAY AVE
BISMARCK ND
58501-4756
US

IV. Provider business mailing address

1800 E BROADWAY AVE
BISMARCK ND
58501-4756
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5626
  • Fax:
Mailing address:
  • Phone: 701-323-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1543-5-15-26A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: