Healthcare Provider Details

I. General information

NPI: 1689580318
Provider Name (Legal Business Name): WEST RIVER RECOVERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MAIN ST. #7
CARSON ND
58529
US

IV. Provider business mailing address

410 IDAHO ST N
CARSON ND
58529-4032
US

V. Phone/Fax

Practice location:
  • Phone: 701-920-8379
  • Fax:
Mailing address:
  • Phone: 701-920-8379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANNON WANGSVICK
Title or Position: LAC/RCS/OWNER
Credential: BS/LAC/RCS
Phone: 701-920-8379