Healthcare Provider Details

I. General information

NPI: 1316496680
Provider Name (Legal Business Name): ERIN ROCHELEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 25TH ST S
FARGO ND
58103-2311
US

IV. Provider business mailing address

PO BOX 9859
FARGO ND
58106-9859
US

V. Phone/Fax

Practice location:
  • Phone: 701-451-4855
  • Fax: 651-925-0057
Mailing address:
  • Phone: 701-451-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number885-9-15-16A
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: